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FAIRCHILD'S  HAND-BOOK 

OF    THE 

DIGESTIVE  FERMENTS 


AS   REMEDIES,  PER  SE 
AS  SURGICAL  SOLVENTS 


AND    IN  THE 


PEPTONISAT10N    OF   MILK    AND    OTHER 
FOODS   FOR   THE   SICK 


THE  MODIFICATION  OF  COW'S  MILK  TO  THE 
STANDARD    OF   HUMAN   MILK 

BY  THE  FAIRCHILD  PROCESS 


0 


FAIRCHILD  BROS.   &    FOSTER 


NEW  YORK 
%2    &    84    FULTON    STREET 

LONDON  WESTERN    DEPOT 

SNOW   HILL  BUILDINGS  IIO   RANDOLPH    STREET,    CHICAGO 


Copyrighted  by 

FAIRCHILD  BROS.  &  FOSTER, 

1892,  1893  and  1894. 


fHE  MANY  AND  IMPORT  ANT  USES  OF  THE  DIGESTIVE 
FERMENTS  described  in  this  hand-book,  afford  strik- 
ing evidence  of  the  progress  made  in  their  develop- 
ment in  recent  years.  The  introduction  of  the  Fairchild 
digestive  preparations  and  processes  marked  an  era  in 
applied  physiological  chemistry.  It  was  the  practical 
beginning  of  our  appreciation  of  the  value  of  digestive 
ferments,  of  their  scope  and  service  in  the  nutrition  of  the 
sick.  If,  as  it  has  been  said  by  its  founder,  the  art  of  medi- 
cine owes  its  existence  to  a  recognition  of  the  fact  that 
food  and  regimen  proper  in  health  were  unsuited  to  the 
sick,  surely  the  art  of  medicine  has  made  a  great  advance 
in  learning  to  effect  digestion  by  proxy  ;  by  borrowing  from 
the  lower  animals  the  organic  principles  by  which  food  may 
be  converted  into  the  soluble  form  requisite  for  the  nutrition 
of  the  sick. 

The  modern  application  of  digestive  ferments  by  the 
Fairchild  process  to  the  pre-digestion  of  food  for  the  sick, 
may  be  considered  as  direct  and  scientific  a  develop- 
ment of  the  resources  lying  at  our  hands,  as  is  the  art  of 
cookery  itself,  by  which  we  seek  to  adapt  food  stuffs  to  the 
needs  of  mankind. 

In  no  direction  has  a  digestive  ferment  been  of  more 
positive  benefit  than  in  the  preparation  of  infant  food.  The 
use  of  a  digestive  ferment  as  the  essential  factor  in  the 
preparation  of  an  artificial  human  milk,  was  first  suggested 
by  us  and  brought  to  a  practical  form  in  the  Peptogenic 
Milk  Powder. 

In  this  process,  the  milk  designed  for  the  less  highly 
organised  animal  is  raised  to  the  soluble  form  characteristic 

3 


of  woman's  milk  and  necessary  for  the  human  infant  ; 
whilst  the  secondary  and  quantitative  variance  is  accurately 
adjusted. 

So  strong  is  our  conviction  of  the  soundness  of  the  prin- 
ciples upon  which  this  method  is  based,  and  of  the  accuracy 
with  which  it  is  brought  into  practice,  so  conclusive  the 
evidence  of  its  beneficent  results  in  actual  use,  that  we  feel 
constrained  to  urge  its  claims  to  consideration  as  a  means  of 
obtaining  a  complete  and  exclusive  substitute  for  breast 
milk. 

As  surgical  solvents,  the  digestive  ferments  justify  serious 
attention,  for  they  are  potent,  are  painless  in  their  work,  and 
invade  and  liquefy  dead  tissue  straight  down  to  living  ones, 
where  their  action  ends  abruptly  ;  they  impart,  moreover,  a 
distinct  stimulus  to  the  healing  process. 

Engaging  in  the  manufacture  and  study  of  the  digestive 
ferments  with  an  enthusiasm  based  upon  conviction  of  their 
valuable  properties  and  possibilities  as  therapeutic  and  pep- 
tonising  agents,  we  have  been  happy  to  see  them  win  so 
important  a  place  in  practical  medicine. 

The  Fairchild  preparations  are  each  and  all  the  result  of 
persistent,  careful,  special  work,  and  we  believe  them  to  be 
not  only  the  original,  but  the  best  for  all  purposes  designed. 
They  have  long  been  conceded  to  be  the  standard. 

We  desire  to  take  this  occasion  to  express  again  our 
appreciation  of  the  confidence  and  recognition  so  gener- 
ously accorded  our  efforts  by  the  medical  profession.  It  is 
no  less  a  source  of  pleasure  to  us  that  so  many  of  the  best 
pharmacists  find  our  products  worthy  of  their  preference. 

FAIRCHILD  BROS.  &  FOSTER. 
Revised  Edition,  April,  1894. 


CONTENTS 


DIGESTIVE  FERMENTS — GENERAL  CHARACTERISTICS. 

Action  of ;  Limit  of  energy  ;  Changes  of  alimentary  substances 
by  digestion  ;  In  a  dry  form,  should  not  be  hygroscopic  ;  Dry 
ferments  compatible  with  substances  which  would  injure  them  in 
solution  ;  Dry  compounds  as  subject  to  assay  as  the  separate  fer- 
ments from  which  prepared  ;  Relation  to  temperature  ;  In  solution  ; 
Incompatibility  of  solutions  of  mixed  ferments pp.  14-18 

ALCOHOL  and  the  digestive  ferments  ;  Action  of  strong  and  diluted  ; 
Value  as  a  preservative pp.  i8-2o 

INHIBITANTS.  The  influence  of  drugs  and  dietary  substances  upon  the 
process  of  artificial  digestion  ;  The  relation  of  test  tube  experi- 
ments to  the  conditions  of  body  digestion  ;  necessity  of  dis- 
tinguishing between  substances  which  retard  the  process  of  arti- 
ficial digestion  and  substances  which  destroy  the  ferment,  .pp.  21-24 

INCOMPATIBLES.  Substances  and  conditions  which  destroy  the  digestive 
ferments  ;  Pepsin  and  bismuth  in  solution pp.  25-27 

ANTISEPTICS    ...   pp.  27-28 

41  JUMBLES."  Character  of  the  commercial  digestive  compounds,  their 
good  effects  due  to  pepsin  and  acid p.  28 

VEGETABLE  FERMENT.  Its  inferiority  in  comparison  with  pepsin  in 
acid  media  and  pancreatic  extract  in  alkaline  or  neutral. .  .pp.  29-30 

GASTRIC  FERMENTS.  Pepsin,  its  action  upon  albumen  ;  Peptic  peptone  ; 
Pepsin  inert  in  alkaline  solution  ;  Pepsin  and  soda  ;  Practical  uses 
of  pepsin pp.  30-32 

MILK  CURDLING  FERMENT  of  the  Gastric  Juice.  Its  action  upon 
caseine  ;  Significance  in  the  digestive  process pp.  32-34 

PANCREATIC  FERMENTS.  Trypsin,  Action  of ;  Tryptic  peptones  ;  Pan- 
creatic diastase  ;  Identity  of  diastase  from  all  sources  in  properties 
and  action  ;  Uses  of  Emulsive  Ferment ;  Curdling  ferment 

pp.  34-40 

DOSAGE  of  digestive  ferments pp.  40-41 


6 

FAIRCHILD  PREPARATIONS  of  the  Digestive  Ferments  |  Uniformity  and 
reliability  ;  Their  repute  based  upon  actual,  demonstrated  proper- 
ties ;  Commercial  imitations  and  substitutes  therefor pp.  41-44 

PEPSIN  IN  SCALES  AND  POWDER.  Conformity  to  Pharmacopoeia  re- 
quirements. Pepsin  in  scales  first  introduced  by  Fairchild.  A 
uniformly  excellent  product pp.  44-45 

PEPSIN  SACCHARATED.  Original  standard  of  strength  ;  Present 
standard p.  45 

GLYCERINUM    PEPTICUM.     A   pure  glycerin   extract   from   the  gastric 

membrane,  free  from  alcohol,  antiseptics,  sugar  or  flavoring  ;  The 

'  best  soluble  form  of  pepsin p.  46 

ESSENCE  OF  PEPSINE,  Fairchild's  Obtained  by  direct  maceration  from 
the  fresh  calf  rennet ;  Special  value  as  a  remedy  in  disorders  of 
infancy,  and  dyspepsia  of  adults  ;  As  a  means  of  administering 
drugs  which  disturb  the  digestive  functions  and  impair  the  appetite  ; 
As  a  practical  rennet  agent pp.  47-49 

MEDICATED  JUNKET.  Suggested  by  Dr.  Delavan  ;  Milk-curd  made  with 
Fairchild's  Essence  containing  Potassium  Iodide  in  solution,  the 
curd  holding  iodide  suspended  in  a  very  agreeable  form  pp.  49-50 

PEPSIN  TESTING pp.  51-54 

PANCREATIC  PREPARATIONS.  Extractum  Pancreatis  containing  all  the 
ferments  of  the  pancreas  in  an  active  and  available  form  ;  As  a 
remedy  per  se  ;  As  a  diastasic,  proteolytic  and  emulsifying  agent ; 
Its  special  value  in  intestinal  indigestion pp.  54-59 

TRYPSIN,  Fairchild's.     As  a  solvent  of  diphtheritic  membrane.  . .  .p.   59 

DIASTASIC  ESSENCE  OF  PANCREAS,  especially  for  the  digestion  of  fari- 
naceous foods p.  60 

PEPTONISING  TUBES,  for  the  preparation  of  Peptonised  Milk,  etc.  .p.  61 

DIRECTION  SLIPS.     For  prescribing  Peptonised  Milk,  etc p.  61 

PEPTOGENIC  MILK  POWDER p.  62 

TESTS  for  pancreatic  preparations   pp.  62-64 

DIGESTIVE  TABLETS,  Fairchild's.  Pepsin  Tablets  ;  Pepsin  and  Bismuth 
Tablets  ;  Pepsin,  Bismuth  and  Pancreatic  Tablets  ;  Pepsin  and 
Pancreatine  Tablets  ;  Pepsin  and  Diastase  Tablets  ;  Pepsin,  Bis- 
muth and  Nux  Vomica  Tablets  ;  Compound  Ox  Gall  Tablets  ;  Pan- 
creatic Tablets  ;  Compound  Pancreatic  Tablets  ;  Peptonate  of  Iron 
Tablets  ;  Ferroglobin  Tablets pp.  64-69 

PEPTONISING  PROCESS.  Simplicity,  economy  and  practicability  of ; 
Use  of  soda  in  ;  Reasons  for  diluting  milk  in pp.  69-74 


USES  OF  PEPTONISED  FOODS.  In  Typhoid  Fever  ;  pneumonia  ;  gastric 
ulcer  ;  acute  dysentery  ;  diabetes  ;  tuberculosis  ;  chronic  diarrhoea  ; 
gastric  catarrh  ;  value  as  exclusive  diet  even  in  active  life. pp.  75-78 

PEPTONISED  MILK.     Ideal  food  for  the  sick pp.   79-80 

;'NUTRITIVE  ENEMATA.      Milk,  beef,  etc pp.  80-8 1 

<  PANOPEPTON — Bread  and  Beef  Peptone  ;   a  properly  digested,  complete 
nutrient pp.   82-85 

SURGICAL  USE  of  the  Digestive  Ferments.  As  solvents  for  false 
fibrinous  membrane,  coagula,  muco-pus,  necrotic  and  carious  bone  ; 
applied  in  aural  cavity,  urethra,  bladder,  etc pp.  85-92 

PEPTOGENIC  MILK  POWDER.  For  the  preparation  of  humanised  milk, 
Identical  with  normal  human  milk  in  physical,  chemical  and  physio- 
logical properties  ;  Rationale  of  the  process  ;  Agency  of  the  diges- 
tive ferment  as  an  innocent,  practical,  and  only  known  means  of 
converting  caseine  into  the  soluble  form  characteristic  of  the 
albuminoids  of  human  milk pp.  93-96 

INFANT  FOODS.  Only  practical  point  of  inquiry  ;  How  do  they  compare 
with  breast  milk  when  prepared  for  the  nursing  bottle  ;  Fresh  cows' 
milk  only  practical  basis  for  making  an  infant  food  ;  Milk  Foods, 
etc. ;  Impossibility  of  drying  pure  milk pp.  96-97 

Cows'  MILK.  Proven  inherently  indigestible  for  an  infant's  stomach  ; 
Common  methods  of  preparing  it  for  infants  ;  Liebig's  Food  ; 
Farinaceous  Food pp.  97-99 

COMPARATIVE  COMPOSITION  OF  Cows'  AND  HUMAN  MILK.  Differ- 
ence in  their  physical  characters,  digestibility,  behavior  with  gastric 
juice,  directly  due  to  difference  in  their  albuminoids ;  significant 
difference  also  in  proportion  and  quantity  of  nutritive  materials 

pp.  99-100 

USE  OF  PEPTOGENIC  POWDER.  Includes  the  preparation  of  an  exact 
quantitative  imitation  of  human  milk,  exact  qualitative  change  of 
albuminoids  and  subsequent  destruction  of  the  ferment,  pp.  100-101 

DIRECTIONS  FOR  "HUMANISED  MILK";  in  health  and  in  feeble 
digestion pp.  101-102 

COMPOSITION  OF  "HUMANISED  MILK."  Remarkably  like  average 
breast  milk  in  chemical  constitution,  reaction,  density,  color,  taste 
and  in  behavior  under  all  conditions p.  102 

DIGESTIBILITY  OF  "HUMANISED  MILK";  Not  unnaturally  easy  of 
digestion  ;  as  digestible  as  mothers'  milk  ;  adapted  for  feeble  diges- 
tion by  increasing  the  pre-digestion  of  the  caseine.  ...pp.  103-104 

CHOLERA  INFANTUM.     Whey  as  a  temporary  food  in pp    104-106 


How  LONG  SHOULD  Infant  be  fed  upon  humanised  milk  ;  Human- 
ised milk  the  only  food  suitable  during  entire  nursing  period. p.  106 

How  TO  WEAN  the  bottle  fed   baby , pp.   106-107 

As  A  PARTIAL  SUBSTITUTE  for  Breast  Milk  ;  Humanised  milk  most 
successful  partial  food,  because  so  like  breast  milk p.  107 

No  SPECIAL  EFFECT  upon  the  Bowels  from  "  humanised  milk  " 

pp.   107-109 

CHANGING  THE  FOOD  ;  Evil  of  going  from  one  food  to  another  without 
definite  knowledge  or  basis  of  selection  pp.  109-111 

RICH  MILK  from  one  cow  ;  Cream  :  Temperature  of  the  water  bath  ; 
Milk  tastes  bitter  ;  Milk  curdled  when  boiled pp.  111-114 

CONDENSED  MILK pp.   114-115 

STERILISED  MILK.  Character  of  ;  Effect  of  sterilising  process  ;  less 
digestible  and  far  less  nutritious  than  fresh  milk pp.  115-117 

COMPARATIVE  ANALYSES  average  of  80  samples  of  woman's  milk  and 
of  "  humanised  milk,"  by  Dr.  Albert  R.  Leeds  p.  118 

FAIRCHILD'S  PRACTICAL  RECIPES  ;  For  peptonising  food  for  the  sick  ; 
Nutritive  value  of  milk  compared  with  beef  tea,  extracts  of  beef, 
etc pp.  119-120 

PEPTONISED  MILK.  Warm  process  ;  Cold  process  ;  Hot,  as  a  bever- 
age ;  Effervescent ;  Special  for  jellies,  punches,  etc. ;  Punch  ; 
Lemonade  ;  Peptonised  milk  gruel ;  Peptonised  porridge  ;  Beef  ; 
Oysters  ;  Junket  and  whey  with  Fairchild's  Essence  of  Pepsine  ; 
Partial  digestion  of  farinaceous  foods  at  the  table pp.  121-127 

LIST  OF  FAIRCHILD'S  PREPARATIONS p.  128 


FAIRCHILD'S    HAND-BOOK 


DIGESTIVE   FERMENTS. 


11 

IIS 


2.  3  6  o  o 

In  the  digestive  ferments,  we  have  to  deal  with  an  en- 
tirely distinct  class  of  agents,  bearing  little  or  no  analogy 
to  drugs  and  chemicals.  They  are  not  known  to  exert  any 
action  in  the  body  other  than  that  concerned  in  the  con- 
version of  alimentary  substances  into  soluble  and  absorb- 
able  forms.  By  this  action  alone  we  know  them  and  can 
determine  their  presence. 

No  digestive  ferment  has  been  absolutely  isolated,  conse- 
quently the  chemical  constitution  of  these  principles  is  yet 
a  matter  of  conjecture.  We  do  not  know  how  they  per- 
form their  marvellous  work,  nor  the  exact  chemical  formula 
of  the  various  derivatives  of  digestion.  These  limitations 
to  our  knowledge  of  the  digestive  ferments  do  not  impose 
any  limitations  upon  their  practical  use  ;  for  we  are  able  to 
extract  them  from  the  digestive  juices  or  secreting  glands 
and  to  preserve  them  indefinitely  as  reliable  agents  of  the 
materia  medica.  In  the  test  tube  and  under  operative 
conditions,  they  may  be  made  to  convert  food  stuffs,  just 
as  they  do  within  the  living  body.  We  know  well  the  con- 
ditions under  which  they  act,  what  is  unfavorable  to  their 
action,  what  is  directly  destructive  to  them. 

We  can  as  unerringly  detect  the  presence  of  pepsin  or 
diastase  as  that  of  morphia  or  strychnia.  We  can  readily 
ascertain  the  digestive  power  or  value  of  any  given  product. 
The  physical  changes  of  alimentary  bodies  under  artificial 
digestion  are  so  characteristic,  so  apparent  to  sight  and 
taste,  that  they  afford  convenient  and  familiar  evidence  by 
which  the  peptonising  process  may  be  as  readily  regulated 
as  that  of  cooking. 

It  is  indeed  marvellous  that  we  should  be  able  to  so 
readily  utilise  these  organic  principles  of  the  vital  process 
of  digestion. 


12 

Notwithstanding  these  facts,  there  still  exists  an  im- 
pression that  there  are  peculiar  difficulties  attending  the 
practical  use  of  the  digestive  ferments.  This  has  been  in  a 
large  measure  due  to  current  fallacious  statements  and 
theories,  and  to  erroneous  deductions  from  the  immense 
array  of  experiments  presented,  especially  concerning  those 
showing  the  influence  of  medicinal  and  dietetic  agents 
upon  the  digestive  ferments  and  upon  the  artificial  digestive 
process.  The  truth  is  that  the  digestive  ferments  may  be 
prescribed  with  the  same  certainty,  as  drugs  and  chemicals  ; 
with  as  definite  and  well  grounded  anticipation,  with  as 
little  difficulty  as  regards  incompatibility. 

The  digestive  ferments  find  their  entire  use  in  four  dis- 
tinct directions. 

As  therapeutic  agents — as  remedies  for  indigestion. 

As  peptonising  agents — for  the  artificial  digestion  of 
food. 

As  surgical  solvents — for  the  effectual  and  painless  solu- 
tion of  morbid  tissue,  pus,  diphtheritic  membrane,  etc. 

For  the  preparation  of  "  humanised  milk  " — an  artificial 
human  milk. 

As  remedies  per  se,  as  aids  to  the  digestive  process 
within  the  body,  the  main  concern  of  the  physician  is 
to  avoid  prescribing  the  digestive  ferments  with  sub- 
stances which  injure  them.  In  the  discussion  of  "  Incom- 
patibles,"  these  are  conveniently  summarised  for  reference. 
The  fact  that  a  certain  agent  retards  or  even  inhibits 
artificial  digestion,  by  no  means  indicates  that  this  agent  is 
not  to  be  mixed  with  the  ferment  or  prescribed  in  conjunc- 
tion with  it.  The  influence  of  the  so-called  "  inhibitants  " 
is  ascertained  in  the  test  tube,  where  the  action  of  each 
ferment  is  clogged  even  by  the  products  of  digestion  and 
retarded  by  substances  which  in  the  stomach  would  have 


13 

no  influence  whatever.  In  the  chapter  on  "  Inhabitants," 
the  relation  of  these  experiments  to  the  conditions  of  body 
digestion  and  the  deductions  to  be  drawn  therefrom  are 
fully  discussed. 

In  the  artificial  digestion  of  foods,  the  relation  of  tem- 
perature to  the  digestive  ferments  is  of  great  importance, 
as  simply  by  its  regulation,  we  may  hold  the  ferments  in  a 
latent  form,  may  obtain  their  energetic  action,  or  instantly 
and  permanently  check  action  at  any  given  stage. 

For  the  solution  of  morbid  tissue,  we  have  but  to  employ 
the  special  ferment  indicated,  in  its  proper  vehicle,  and 
remove  by  irrigation  both  the  ferment  and  the  dissolved 
matter. 

The  employment  of  a  digestive  ferment  as  the  essential 
factor  in  the  preparation  of  an  artificial  human  milk,  is  not 
by  any  means  to  be  understood  as  simply  yielding  an 
artificially  digested  food  for  infants,  in  the  sense  that  foods 
perfectly  wholesome  and  digestible  for  healthy  persons  are 
rendered  suitable  for  the  sick  by  artificial  digestion.  On 
the  contrary,  it  is  a  process  by  which  cow's  milk,  primarily 
unfit  for  the  most  vigorous,  healthy,  infant  digestion,  and 
dissimilar  to  human  milk  in  physiological,  chemical  and 
nutritive  properties,  is  brought  to  an  active  resemblance  to 
mothers'  milk  in  every  detail — in  density,,  color,  taste, 
chemical  composition  and  digestibility. 

This  highly  important  and  successful  application  of  the 
digestive  ferments  was  first  suggested  by  us  and  brought 
to  a  practicable  form  suitable  for  household  use.  The 
rationale  of  this  process  is  fully  described  in  the  chapter 
on  the  Peptogenic  Milk  Powder.  A  thorough  consideration 
of  the  facts  there  presented  must  lead  to  the  conclusion 
that  the  process  is  based  upon  correct  premises  ;  is  accu- 
rately carried  out  on  the  basis  of  adequate  study  of  the 


14 

physiological  characteristics  and  comparative  analysis  of 
cow's  and  of  human  milk,  and  of  the  action  of  the  digestive 
ferments. 

The  certainty  with  which  the  Fairchild  preparations  of 
the  digestive  ferments  act,  either  upon  alimentary  bodies, 
or  morbid  tissues,  affords  sufficient  proof  that  the  digestive 
ferments  are  not  necessarily  variable  or  unreliable  agents. 

Our  work  with  the  digestive  ferments  has  been  of  that 
practical  character  involved  in  the  production  of  these 
organic  principles  in  the  most  active  and  best  form  ;  and 
in  the  invention  and  development  of  preparations  and 
processes  for  their  application.  In  the  following  pages,  we 
have  sought  to  present  the  salient  facts  concerning  the 
digestive  ferments  in  the  whole  range  of  their  relations 
to  the  conditions  and  agents  with  which  they  are  prac- 
tically brought  into  contact,  and  to  describe  the  proper 
methods  for  their  employment  as  therapeutic  and  pepton- 
ising  agents. 


DIGESTIVE      FERMENTS. 

GENERAL   CHARACTERISTICS. 

The  digestive  ferments  belong  to  the  class  of  soluble 
unorganised  ferments,  possessing  no  power  of  self-nutrition 
or  self-multiplication.  They  differ  entirely  in  their  mode 
of  action  from  living  ferments,  such  as  yeast  or  bacteria. 
Their  action  is  further  unaccompanied  by  the  phenomena 
ordinarily  associated  with  fermentation.  They  may  be 
described  as  agents  capable  of  setting  up  between  sub- 
stances, under  conditions  of  moderate  temperature,  a  chem- 
ical action  of  which  these  substances  are  incapable  without 
the  intervention  of  the  ferment.  The  digestive  ferments 
probably  belong  to  the  proteid  class,  or  are  closely  related 
thereto.  At  present  in  the  most  active  form  in  which  they 


15 

are  practically  obtained,  they  are  found  to  correspond  in 
behavior  and  constitution  to  proteid  bodies.  They  are  all 
soluble  in  water,  and  by  simple  infusion  of  the  fresh  gland 
or  the  secreting  membrane,  we  may  obtain  active  solutions 
which  exhibit  in  the  proper  media  all  the  behavior  of  the 
natural  juices.  The  digestive  ferments  possess  enormous 
energy,  being  capable,  even  in  the  form  in  which  they  have 
been  practically  separated,  of  converting  into  solution 
many  thousand  times  their  weight  of  alimentary  substance. 

Stress  has  been  laid  upon  the  fact  that  a  ferment  after 
having  performed  a  certain  amount  of  digestion  may  be 
recovered  and  made  to  repeat  its  work,  and  it  has  been  by 
some  writers  assumed  that  the  power  of  a  ferment  is  limit- 
less. Even  if  this  theory  were  true,  it  has  no  bearing  upon 
ordinary  operations  with  a  digestive  ferment  upon  its  corre- 
lated substance,  for  the  purpose  of  determining  its  extent  of 
energy  under  practical  conditions,  or  of  utilising  its  force 
for  any  practical  purpose.  For  instance,  for  the  artificial 
solution  of  alimentary  substances,  and  morbid  tissues, 
etc.,  or  as  aids  to  digestion.  Nor  is  it  of  any  significance 
as  to  the  role  of  the  ferment  in  the  normal  process  of 
digestion. 

It  is,  however,  a  fact  that  the  digestive  ferment  has  a 
definite,  ascertainable  limit  of  energy  ;  its  power  is  used  up 
just  in  proportion  to  the  work  done. 

When  under  certain  conditions  favorable  to  digestion, 
with  arbitrary  proportions  of  alimentary  substance  and 
media,  a  point  is  found  at  which  a  given  amount  of  ferment 
leaves  a  large  excess  of  substance  unaffected,  it  is  because 
the  ferment  has  lost  all  its  power.  Thus  in  a  series  of 
experiments  with  increasing  ratio  of  substance  to  ferment, 
we  ascertain  the  relative  as  well  as  actual  power  of  pepsin 
or  of  diastase. 

The  characteristic  action  of  the  digestive  ferment  is 


16 

the  conversion  of  alimentary  substances  into  the  peculiar 
soluble  form  essential  to  their  absorption.  But  the  action 
of  the  ferments  is  not  restricted  to  alimentary  bodies  ; 
the  proteolytic  ferments,  both  of  the  stomach  and  the 
pancreas  gland,  are  capable  of  digesting  albuminous  or 
fibrinous  substances,  such  as  false  membranes,  coagula,  etc. 

It  is  under  physiological  conditions  that  the  ferments 
produce  changes  which  can  otherwise  only  be  approximated 
under  high  temperature  and  chemical  reagents ;  as,  for 
instance,  in  the  making  of  peptones  or  glucose  by  prolonged 
boiling  with  acid.  By  the  action  of  the  digestive  fer- 
ments alimentary  bodies  undergo  visible  and  profound 
changes  in  their  physical  properties,  of  great  physiological 
significance,  rendering  them  highly  susceptible  of  osmosis, 
whilst  their  chemical  composition  is  but  slightly  altered. 
In  order  to  distinguish  the  digestive  ferments  from  living 
or  organised  ferments,  Kuhne  proposed  to  call  them 
enzymes,  and  further  it  has  been  proposed  to  distinguish 
their  action  as  enzymatic,  in  contrast  to  true  fermentation. 
But  these  terms  have  but  little  practical  recognition,  and 
the  distinctions  between  digestive  ferments  and  living, 
yeast,  or  germ  ferments,  are  now  so  well  understood  that 
the  use  of  the  term  "  digestive  ferments  "  really  leads  to 
little  confusion. 

In  a  dry  form  the  digestive  ferments  permanently  retain 
their  properties.  For  inasmuch  as  water  is  essential  to  the 
action  of  the  digestive  ferment  so  the  presence  of  water  is 
essential  to  its  reaction  with  any  other  substance.  Moisture 
and  heat  are  favorable  to  their  decomposition.  An  essential 
quality  of  dry  products  of  the  digestive  ferments  is,  that 
they  shall  not  be  prone  to  absorb  moisture — shall  not  be 
hygroscopic.  They  should  never  be  prescribed  in  combina- 
tion with  deliquescent  salts,  peptone,  etc.  A  digestive 
ferment  may  properly  be  combined  in  a  dry  form  with  sub- 
stances with  which  it  should  not  be  brought  into  contact  in 


17 

solution.     Thus  dry  pepsin  will  not  be  injured  by  contact 
with  soda  bicarbonate. 

Obviously  in  a  dry  form,  the  digestive  ferments  are  with- 
out action  towards  each  other.  Therefore,  a  mixture  of 
these  ferments  should  retain,  and  under  proper  conditions, 
must  exhibit  the  behavior  characteristic  of  each  one  of  the 
ferments  contained.  For  with  several  ferments  placed  in  a 
digesting  mass,  those  under  conditions  unfavorable  to  action 
have  no  possible  interference  with  the  action  of  the  partic- 
ular ferment  for  which  the  conditions  are  appropriate.  A 
digestive  compound  is  therefore,  in  every  particular,  as 
subject  to  assay  as  the  separate  ferments  from  which  it  is 
prepared.  For  instance,  if  a  powder  contains  "  pepsin, 
pancreatine  and  diastase,"  it  should  in  acidulated  water, 
give  all  the  results  of  the  contained  quantity  of  pepsin,  in 
an  alkaline  medium  it  should  digest  fibrin  or  milk,  and  in  a 
neutral  or  alkaline  solution  liquefy  gelatinous  starch.  What- 
ever theory  or  opinion  may  be  held  concerning  the  propriety 
of  such  combinations,  it  must  certainly  be  obvious  that 
their  value  as  digestive  agents  must  as  much  depend  upon 
the  possession  of  the  digestive  properties  of  the  various 
ferments,  as  the  value  of  a  preparation  of  pepsin  or  of  pan- 
creatic extract  is  measured  by  the  degree  in  which  it  ex- 
hibits peptic  or  pancreatic  activity. 

The  digestive  ferments  are  inert  but  not  injured,  at  a  low 
temperature.  They  bear  prolonged  exposure  to  the  freez- 
ing-point without  becoming  impaired.  In  solution,  at  the 
ordinary  temperature  of  a  room,  70°  "F.,  they  act  slowly 
favorably  at  the  temperature  of  the  body,  and  increas- 
ingly up  to  about  130°  F.,  when  as  the  temperature  rises 
they  sharply  diminish  in  activity  until  at  about  160°  F., 
they  are  quite  destroyed. 

Pepsin  is  active  only  with  acid  ;  pancreatic  ferments  in 
neutral,  alkaline  and  feebly  acid  solutions. 


It  is  impossible  to  prepare  a  menstruum  suitable  for 
the  solution  and  preservation  of  mixed  ferments  of  the 
pancreas  and  the  stomach.  If  we  mix  active  solutions  of 
the  stomach  and  of  the  pancreas  and  test  the  mixture  after 
it  has  been  set  aside  at  the  ordinary  temperature  of  the 
room  for  a  few  days,  it  will  be  found  that  the  mixture  no 
longer  represents  all  the  digestive  ferments  as  contained 
in  the  original  solutions.  If  the  reaction  of  the  solution 
of  the  mixed  ferments  has  been  neutral  or  alkaline,  the 
pepsin  will  have  been  destroyed  ;  if  acid,  the  pancreatic 
ferments  will  have  lost  their  properties.  It  may  be  said, 
therefore,  without  qualification,  that  the  whole  class  of 
fluid  mixtures  of  gastric  and  pancreatic  ferments  are  un- 
scientific, and  invariably  devoid  of  most  of  the  ferments 
they  purport  to  contain. 

ALCOHOL  AND  THE  DIGESTIVE  FERMENTS. 

The  digestive  ferments  vary  so  little  in  their  behavior 
with  alcohol,  that  they  may  all  be  said  to  bear  a  common 
relation  to  it.  They  are  insoluble  in  alcohol,  soluble  in 
diluted  alcohol  and  precipitated  from  solution  by  alcohol  in 
excess. 

To  effectually  employ  alcohol  as  a  precipitant  of  the 
ferments,  they  must  be  held  in  a  concentrated  solution,  to 
which  the  stronger  alcohol  must  be  added  in  such  a  volume 
as  to  give  the  largest  practicable  percentage  of  absolute 
alcohol.  The  ferments  so  recovered,  may  again  be  re- 
dissolved  in  water. 

That  alcohol  does  not  destroy  the  ferments,  may  be 
seen  in  the  method  commonly  employed  by  physiological 
chemists,  in  extracting  the  ferments  in  a  pure  solution 
convenient  for  experimental  purposes.  The  mucous  mem- 
brane or  gland  is  first  exposed  to  alcohol  which  washes, 
hardens  and  dehydrates  it ;  then  to  a  solvent  (glycerin 


19 


preferably)  which  takes  up  the  ferment  largely  free  from 
inert  extractives,  coloring  matter,  etc. 

But  notwithstanding  the  fact  that  alcohol  is  thus  recom- 
mended in  leading  works  on  physiology,  we  have  been 
unable  to  convince  ourselves  that  strong  alcohol  does  not 
exert  a  direct  injurious  action  on  the  ferments.  The  alco- 
hol separated  ferment  does  not  exhibit  the  activity  which 
it  should  theoretically  possess,  calculated  upon  the  degree 
of  isolation  and  the  known  assayed  ferment  power  of  the 
original  infusion  of  the  gland.  But  the  degree  of  activ- 
ity suitable  for  the  physiological  chemist,  who  simply 
requires  solutions  of  the  ferments  capable  of  exhibiting  the 
characteristic  reaction,  is  no  doubt  far  inferior  to  the 
standard  attained  by  the  manufacturing  chemist  in  apply- 
ing ferments  to  practical  purposes. 

From  a  pharmaceutical  standpoint,  alcohol  bears  in  some 
respects  the  relation  to  the  digestive  ferments  that  it  does 
to  many  drugs.  A  watery  infusion  from  the  stomach,  like 
all  other  infusions  of  organic  substances,  will  soon  de- 
compose and  the  ferments  therein  will  lose  all  activity 
unless  there  is  some  preservative  added.  A  hydro-alcoholic 
menstruum  serves  as  useful  a  purpose  in  extracting  the 
digestive  ferments  as  it  does  in  extracting  the  active  prin- 
ciple of  drugs.  The  first  desideratum  of  fluid  preparations 
is  that  they  should  present  effective  doses  in  a  moderate 
volume.  With  a  menstruum  containing  say  15  to  20  per 
cent,  of  pure  spirit,  all  the  ferments  may  be  extracted  and 
preserved  in  an  effective  form  for  medicinal  purposes 
or  for  use  in  the  artificial  digestion  of  food.  It  is  not 
by  any  means  a  sufficient  cause  for  the  rejection  of  this 
class  of  preparations,  merely  that  they  contain  alcohol 
up  to  say  20  per  cent,  of  volume.  In  the  percentage 
sufficient  as  a  preservative,  alcohol  does  not  necessarily 
injure  the  ferments  or  render  them  inert.  As  present  in  this 


20 

proportion  it  becomes  an  insignificant  factor  in  so  far  as  it 
affects  the  value  of  a  digestive  fluid,  owing  to  the  dilution 
it  will  receive  in  practical  uses. 

We  must  require  of  such  a  preparation  as  the  essential 
ground  of  its  employment,  that  it  shall  exhibit  actual  diges- 
tive power,  the  characteristic  action  of  the  ferment  which  it 
purports  to  represent,  when  submitted  to  the  identical  con- 
ditions used  in  assaying  the  dry  ferments  themselves. 

The  solutions  or  liquid  extracts  from  the  pancreas  are 
objectionable  and  inferior  to  the  dry  Extractum  Pancreatis, 
not  because  of  the  20  p.  c.  of  alcohol,  but  because  of 
the  tendency  of  these  solutions  to  precipitate,  to  undergo 
deterioration  owing  to  the  large  amount  of  organic  matter 
they  contain.  The  diastasic  power  is  especially  variable 
and  weak,  and  tends  to  constantly  diminish.  These  solu- 
tions further  impart  their  peculiar  repulsive  taste  to  foods, 
milk,  gruel,  etc.,  and  consequently  they  have  found  little 
usage,  and  now  are  entirely  superseded  by  the  Extractum 
Pancreatis. 

The  influence  which  alcohol  exerts  upon  the  artificial 
process  of  digestion,  its  bearing  upon  the  proper  use  of 
alcohol  in  fluid  preparations  of  the  digestive  ferments,  will 
be  discussed  when  we  come  to  consider  the  subject  of 
inhabitants  or  substances  which  retard  artificial  digestion 
in  the  flask  or  test  tube. 

That  many  of  the  class  of  preparations,  such  as  wines, 
elixirs,etc.,  are  inefficient,  is  not  due  to  thepresenceof  alcohol, 
but  for  the  reason  that  they  have  not  been  properly  pre- 
pared, or  have  been  made  from  commercial  products 
originally  deficient  in  digestive  properties.  For  this  class  of 
preparations  of  the  digestive  ferments  will  be  found  to  vary 
very  much,  as  do  galenical  preparations  generally,  according 
to  the  skill  and  technical  knowledge  exercised  in  their 
manufacture. 


21 

INHIBITANTS. 

No  question  concerning  the  digestive  ferments  has 
been  given  more  attention  than  the  influence  of  medici- 
cinal  and  dietary  substances  upon  the  process  of  artificial 
digestion.  It  has  been  the  subject  of  many  experiments 
and  raised  many  speculations.  We  have  had  elaborate 
tests,  giving  the  exact  observed  degree  of  retardation 
exhibited  by  a  great  variety  of  drugs  and  chemicals, 
some  of  which  would  scarcely  by  any  chance  ever  be 
mixed  with  a  digestive  ferment  in  practice  ;  also  of  the 
effect  of  alcohol,  wine,  spirits,  beer,  tea,  cocoa,  coffee, 
whey,  sugar,  common  salt,  etc.  That  various  observers 
reach  conflicting  results  and  conclusions  is  due  to  the 
fact  that  no  two  employ  digestive  fluids  of  the  same 
strength  or  follow  precisely  the  same  method  in  detail. 
Whilst  these  experiments  are  very  interesting  and  attrac- 
tive, the  real  point  of  inquiry  must  be  to  determine  their 
practical  bearing  in  medicine  and  pharmacy.  There  is  a 
very  necessary  distinction  to  be  drawn  between  the 
action  of  substances  upon  the  ferments  direct  and  upon 
the  digestive  process.  It  is  of  the  greatest  importance 
to  the  physician  and  the  pharmacist  to  know  the  agents 
which  destroy  the  ferment  when  brought  into  contact 
with  it.  But  as  to  the  practical  significance  of  this  whole 
class  of  experiments  showing  the  retarding  effect  of  sub- 
stances upon  the  process  of  digestion,  we  must  consider 
what  relation  or  resemblance  exists  between  the  condi- 
tions in  the  test  tube  and  in  the  living  body.  We  must 
ask  why  and  how  these  agents  retard  digestion  and  if 
they  are  likely  to  produce  similar  results  when  they  are 
taken  into  the  body.  The  common  method  of  experi- 
ment is  to  take,  say  with  pepsin  for  illustration,  a  definite 
amount  of  the  ferment,  albumen,  acid  and  water  up  to  an 
arbitrary  volume,  the  proportions  adjusted  to  produce  a 
known  amount  of  digestion  in  a  definite  time  at  blood 


22 


heat.  This  constitutes  the  control  test.  Into  this  mix- 
ture, in  a  series  of  tubes,  are  added  the  agents  to  be 
tested  and  the  effect  upon  digestion  noted.  These  con- 
ditions in  the  test  tube  imitate  those  of  the  digestive 
tract  in  temperature  and  in  media  ;  they  differ  therefrom 
in  material  points.  In  the  test  tubes,  the  very  accuracy 
of  the  proportions  of  the  mixture,  whilst  essential  to  cor- 
rect observation  in  experiments,  in  reality  involves  a  great 
fallacy.  Water  is  essential  to  all  physiological  action  ; 
water  is  the  only  fluid  in  which  and  by  which  a  digestive 
ferment  can  act  upon  an  alimentary  substance.  In  the 
stomach  and  intestinal  canal  there  is  not  an  arbitrary  fixed 
volume  of  liquid,  which  may  be  to  a  definite  and  known 
degree  altered  by  the  addition  of  any  substance.  In  the 
normal  digestive  apparatus,  the  ferment  may  be  said  to 
act  in  a  current  of  water  ;  there  is  a  constant  secretion 
of  digestive  juices  during  the  entire  period  of  action. 
There  is  meanwhile  a  marked  fluctuation  in  the  reaction 
and  the  composition  of  the  digesting  mass,  owing  to  the 
very  complex  nature  of  the  substances  of  food  and  the 
more  or  less  definite  chemical  changes  and  combinations 
formed  therefrom.  The  products  of  digestion,  the  saline 
constituents  of  food,  are  continuously  absorbed  in  the 
digestive  tract,  leaving  the  digestive  juice  unhampered 
in  its  work.  In  the  test  tube,  in  the  "control,"  the 
first  essential  is  a  fixed  volume  of  water.  Now  if  in 
another  tube,  we  add  a  substance  which  reduces  the  pro- 
portion of  water  to  any  marked  extent,  we  shall  find,  as 
may  only  be  anticipated,  that  we  get  less  digestion.  A 
tube  containing  80  per  cent,  of  water  and  20  per  cent,  of 
alcohol  or  glycerin  or  sugar  or  peptone,  will  give  less 
result,  not  because  these  substances  injure  the  ferment, 
but  because  they  cannot  replace  water,  because  of  the 
lessened  value  of  the  media  for  digestive  action.  Pure 
glycerin  exerts  no  injurious  action  upon  a  ferment,  but 


23 

the  ferment  cannot  transform  albumen  into  peptone  in 
glycerin.  Again,  we  see  in  artificial  digestive  operations 
that  when  the  fluid  has  become  saturated  with  the  prod- 
ucts of  digestion,  the  ferment  can  act  no  further  ;  not 
because  peptone  injures  pepsin  or  maltose  injures  dias- 
tase, but  because  the  water  can  take  up  no  more  and  has 
no  further  power  as  a  medium  for  the  ferment.  Pure 
alcohol  in  excess  is  a  precipitant  of  pepsin,  of  albumen 
and  of  peptone.  About  10  per  cent,  absolute  alcohol  dis- 
tinctly retards  digestion  in  a  test  tube,  but  not  because  it 
is  in  this  percentage  injurious  to  the  ferment.  On  the 
contrary,  as  already  shown,  in  the  proportion  of  15  to  20 
per  cent,  it  affords  a  most  valued  preservative  of  infusion 
of  the  ferments.  Other  substances  retard  digestion  sim- 
ply because  they  reduce  or  change  the  reaction  of  the 
media,  as  shown  for  example  in  peptic  digestion  by  the 
fact  that  if  the  saturating  power  of  an  added  substance 
is  compensated  for  by  the  addition  of  free  acid  to  the 
percentage  of  the  control,  little  or  no  retardation  is  found. 
The  retarding  influence  of  certain  substances  is  modified 
by. the  strength  of  the  digestive  fluid— for  instance,  by 
the  proportion  of  the  pepsin  to  the  albumen.  If  we  take 
the  utmost  limit  of  albumen  which  a  grain  of  pepsin  can 
digest  in  several  hours,  say  2,000  grains,  we  shall  find 
the  digesting  mass  much  more  sensitive  to  salt,  for 
instance,  than  one  containing  a  grain  of  the  same 
pepsin  to  200  grains  albumen  ;  the  percentage  of  salt 
being  the  same  in  each  case.  This  would  seem  to  show 
that  a  powerful  digestion  is  not  affected  like  a  feeble 
digestion — the  retardation  is  relative  not  absolute.  In 
the  behavior  of  common  salt  in  artificial  peptic  digestion, 
we  have  an  illustration  of  the  inadequacy  of  tests  of 
"  inhibitants "  as  guides  to  therapeutic  uses  of  the 
digestive  ferments,  or  as  explaining  or  approximating,  to 
the  digestion  in  the  body.  Salt  strongly  retards  the 


24 


action  of  pepsin  upon  albumen  in  the  test  tube.  It 
does  not  injure  the  ferment.  On  the  contrary,  it  is 
a  well  known  precipitant  and  preservative  of  pepsin. 
Salt  inhibits  digestion  in  a  percentage  which  does 
not  throw  out  the  pepsin,  nor  affect  the  solvent 
action  of  water  upon  peptone,  nor  alter  the  reaction  of 
the  digesting  mass.  In  view  of  these  facts  and  of  the 
universal  use  of  salt  as  a  condiment  and  antiseptic,  we 
are  at  a  loss  to  explain  its  retarding  effects  in  artificial 
digestion  and  cannot  believe  it  to  exert  any  similar  effect 
in  the  stomach. 

The  stomach,  moreover,  is  endowed  with  the  power  of 
maintaining  the  physiological  conditions  essential  to  diges- 
tion. The  ingestion  of  an  alkali  may  neutralise  morbific 
acids  and  provoke  the  secretion  of  the  acids  of  digestion. 
Acids  form  various  combinations  with  proteids  and  bases 
of  food  substances.  Substances  may,  like  alcohol,  retard 
digestion  in  a  test  tube,  yet  stimulate  the  secretions  of  the 
mucous  membrane  or  be  so  rapidly  absorbed  as  to  have 
but  a  passing  effect  in  so  far  as  they  become  a  factor  in 
the  digestive  process,  or  in  altering  either  the  composition 
or  reactions  of  the  digesting  mass.  In  the  medicinal  use 
of  the  most  pronounced  retarding  substances,  they  will 
seldom  or  never  be  so  given  as  to  impart  to  the  digestive 
fluids  the  percentage  which  has  been  found  inhibitory  in 
the  test  tube.  There  are  few  soluble  medicinal  substances 
which,  in  some  proportion,  do  not  exhibit  retarding  action 
under  test  tube  conditions.  Experience,  long  in  advance 
of  these  experiments  in  artificial  digestion,  has  disclosed 
the  disturbing  effects  upon  digestion  of  both  dietary  and 
medicinal  substances,  due  to  conditions  quite  apart  from 
those  of  the  test  tube,  and  in  which  these  experiments 
afford  but  little  practical  significance. 


25 


INCOMPATIBLES. 

SUBSTANCES    AND    CONDITIONS    WHICH    DESTROY    THE 
DIGESTIVE    FERMENTS. 

It  is  remarkable  that  there  exists  so  little  difficulty 
in  the  practical  use  of  the  digestive  ferments.  It  is  not 
considered  a  hardship  that  nitrate  of  silver  must  foe  ex- 
cluded from  light,  or  anaesthetics  from  evaporation  ;  or 
that  hypodermic  solutions  must  be  freshly  prepared. 
Whilst  the  incompatibility  of  drugs  and  chemicals  extends 
to  the  formation  of  dangerous  compounds  from  simple 
mixtures,  the  digestive  ferments  have  practically  but 
one  sort  of  incompatibility  to  be  avoided  in  dispen- 
ing  or  prescribing;  that  of  substances  or  influences 
which  render  them  inert.  The  manufacturer  should 
not  offer  and  the  physician  will  not  knowingly  prescribe 
combinations,  which  are  or  are  likely  to  become  inert  by 
the  time  they  reach  the  patient's  hands.  Of  all  the  con- 
ditions and  substances  with  which  the  digestive  ferments 
are  brought  into  contact  in  their  practical  use,  we  may 
conveniently  summarise  those  which  render  the  ferment 
inert. 

A  digestive  ferment  should  never  be  mixed  with  water 
or  any  fluid  of  a  higher  temperature  than  can  readily 
be  borne  by  the  mouth.  In  the  peptonising  process,  in 
"  sprays,"  in  "  surgical  solvents,"  too  high  temperature 
should  be  carefully  avoided.  Pepsin  is  destroyed  in  alka- 
line solutions — with  lime  water,  sodium  bicarbonate, 
aromatic  spirits  of  ammonia,  etc.  All  ferments  in  solution 
soon  decompose  unless  in  the  presence  of  an  antiseptic. 
Therefore,  a  mixture  of  trypsin,  or  pancreatic  extract, 
water  and  soda  can  not  be  expected  to  keep  indefinitely. 
The  ferments  should  not  be  mixed  undiluted  with  strong 
alcoholic  tinctures,  or  astringents.  Pancreatic  ferments 
should  not  be  placed  in  acid  mixtures.  Pepsin  and  pan- 


26 


creatic  ferments  should  not  be  mixed  together  in  solu- 
tions acid  or  alkaline.  These  mixed  ferments  can  not 
be  permanently  held  in  an  active  form  in  any  solution — 
elixir  or  whatever  it  may  be  called. 

In  using  a  digestive  ferment,  it  does  not  matter  whether 
the  ferment  is  in  solution  or  suspended  in  a  mixture  ; 
whether  the  substance  with  which  it  is  mixed  is  known 
to  retard  digestion  in  a  test  tube  ;  the  main  point  is  that 
the  ferment  shall  not  be  destroyed — that  it  be  exhibited 
in  an  active  form. 


PEPSIN  AND  BISMUTH  IN  SOLUTION. 

Bismuth  in  solution  is  incompatible  with  pepsin.  Pep- 
sin and  the  insoluble  salts  of  bismuth,  the  subnitrate 
or  the  subcarbonate,  is  one  of  the  most  efficient  and  gen- 
erally used  combinations.  Obviously  these  salts  of  bis- 
muth exert  no  influence  upon  pepsin  in  the  dry  state,  nor 
are 'they  injurious  to  the  ferment  when  mixed  with  it  in 
the  fluid  form.  Therefore  the  bismuth  subnitrate  may  be 
properly  given,  for  instance,  in  Fairchild's  Essence  of 
Pepsine,  or  in  the  Glycerinum  Pepticum.  But  the  soluble 
salt  of  bismuth,  the  ammonia  citrate,  cannot  be  combined 
with  pepsin  in  solution  without  rendering  the  ferment 
inert,  as  we  pointed  out  ten  years  ago.  This  fact  has 
been  repeatedly  adduced  by  pharmaceutical  writers,  and 
the  elixirs  of  pepsin  and  bismuth  have  quite  lost  their 
vogue  ;  there  is  but  a  very  limited  demand  for  them. 
Before  the  digestive  valuelessness  of  this  pepsin  and  bis- 
muth elixir  was  known,  the  main  attention  of  pharmacists 
was  directed  in  the  endeavor  to  overcome  the  chemical 
or  pharmaceutical  incompatibilities  of  this  combination. 
This  was  due  to  the  use  of  hydrochloric  acid  as  a  solvent, 
or  to  pepsin  containing  this  acid,  and  an  unstable  solu- 


tion  of  bismuth  was  thus  yielded  in  spite  of  the  neutralisation 
with  ammonia.  Consequently  the  employment  of  citric 
acid  which  gives  a  satisfactory  pharmaceutical  preparation 
has  been  advocated,  and  from  time  to  time  new  formu- 
las for  elixir  of  pepsin  and  bismuth  appear.  But  however 
combined  or  skillfully  prepared,  it  will  be  found  that  the 
bismuth  in  solution  has  rendered  the  ferment  inert.  The 
elixirs  of  pepsin  and  bismuth  are  invariably  found  upon 
assay  to  be  completely  devoid  of  any  digestive  action. 
The  good  they  do  is  from  the  bismuth,  alcohol,  the 
aromatics,  etc.  Consequently  this  elixir  of  bismuth  and 
pepsin  should  be  discarded,  and  it  is  to  be  regretted 
that  it  has  found  a  place  in  any  "  formulas,"  and  thus 
encouragement  given  to  a  palpably  improper  combina- 
tion. 

• 

ANTISEPTICS. 

The  influence  of  antiseptics  upon  the  digestive  ferments 
is  of  great  practical  importance.  Alcohol,  glycerin  and 
common  salt  are  the  most  available  technically — both  in 
the  pharmaceutical  preparations  of  the  digestive  ferments 
and  the  preservation  of  solutions  of  peptonised  products. 
Brine  extracts  the  rennet  and  some  of  the  pancreatic  fer- 
ments. Other  antiseptics,  borax,  boracic  acid,  salicylic  acid, 
thymol,  etc.,  render  infusions  of  the  ferments  stable.  But 
this  class  of  antiseptics  should  not  be  resorted  to,  for  every- 
where in  food  stuffs,  beverages,  etc.,  they  are  distrusted  and 
not  permitted  as  a  substitute  for  alcohol.  They  are  not 
permissible  unless  directed  by  the  physician.  There  are 
antiseptics  which  may  be  so  freely  used  in  a  digesting 
mass  as  to  prevent  all  ulterior  or  putrefactive  changes 
and  yet  not  interfere  with  the  action  of  the  digestive 
ferments.  Creosote  is  remarkable  for  this  property 
and  when  introduced  in  the  pancreatic  digestion  of  milk, 


28 

fibrin,  etc.,  the  usual  digestive  transformation  takes  place 
without  the  occurence  of  fermentative  changes,  even  after 
many  hours.  Pure  creosote  is  therefore  justly  regarded 
as  a  most  valuable  medicinal  antiseptic  to  prevent  fermen- 
tative changes,  especially  in  the  intestinal  tract. 

"JUMBLES." 

There  is  a  certain  class  of  digestive  compounds  which 
have  been  aptly  characterised  and  condemned  by  Fother- 
gill  as  unscientific  "jumbles."  There  is  an  objection 
to  these  jumbles  more  serious  than  any  based  upon  theory 
as  to  the  propriety  of  mixing  up  all  the  agents  of  diges- 
tion with  acids  and  milk  sugar.  Indeed,  there  has  never 
been  any  conclusive  argument  against  efficient  combina- 
tions of  the  various  ferments,  and  many  physicians  employ 
tablets  of  "  Fairchild's  "  Pepsin  and  Pancreatic*  Extract. 
So  whatever  our  theory  about  digestive  compounds, 
certainly  a  compound  can  be  judged  only  by  its  actual 
digestive  value,  just  as  we  judge  or  value  the  single  fer- 
ments. Nothing  can  be  easier  than  to  triturate  powders 
of  pepsin  and  pancreatic  ferments,  and  such  a  mixture 
will  exhibit  all  the  properties  of  each  one  of  the  fer- 
ments. Notwithstanding  this,  most  of  these  compounds, 
"pepsin,  pancreatine,  diastase  and  acids,"  do  not  contain 
any  other  ferment  besides  pepsin  ;  consequently  there 
can  be  no  escape  from  the  conclusion  that  their  value 
as  remedies  depends  solely  on  the  pepsin  and  acid  they 
contain.  Such  compounds  have  been  again  and  again 
condemned  for  their  defective  and  deceptive  character  by 
competent  medical  and  pharmaceutical  writers.  There  is  a 
fallacy  that  is  fast  being  ventilated,  in  the  pretence  that 
such  compounds  possess  peculiar  remedial  or  "clinical" 
value,  in  spite  of  their  failure  to  show  digestive  action.  The 
use  of  these  compounds  is  one  of  the  strongest  evidences 
of  the  value  of  pepsin,  even  when  diluted  with  milk  sugar. 


29 
VEGETABLE   FERMENT. 

The  property  of  certain  vegetable  "  milk  juices,"  of 
softening  or  liquefying  fibrin  and  albumen,  has  long  been 
known.  It  has  been  of  speculative  interest  to  the  botanist 
and  physiologist  ;  but  these  exceptional  instances  of  the 
presence  in  plants  of  a  proteolytic  ferment  of  no  discover- 
able relation  to  their  nutrition  is  without  physiological 
significance.  It  is  of  practical  import  to  the  physician 
only  to  the  extent  in  which  these  vegetable  substances 
may  prove  to  possess  any  superiority  to  the  animal 
proteolytic  ferments.  These  vegetable  principles  have 
been  the  subject  of  considerable  experiment  in  various 
quarters  without  the  appearance,  to  our  knowledge,  of  any 
data  showing  their  especial  utility  or  availability.  On 
the  contrary,  they  have  been  deemed  far  weaker  than  the 
animal  ferments.  In  order  to  ascertain  for  ourselves  the 
properties  and  comparative  value  of  the  vegetable  prod- 
ucts we,  years  ago,  obtained  specimens  of  dried  milk 
juice,  and  the  so-called  active  principles  thereof,  and  sub- 
jected them  to  assay  in  acidulated  water,  under  the  usual 
range  of  conditions  competent  for  pepsin,  and  with 
alkaline  and  neutral  water,  under  the  conditions  suitable 
for  pancreatic  extract.  Subsequently  we  have,  from  time 
to  time,  tested  specimens  submitted  to  us  by  parties  pro- 
posing to  introduce  the  vegetable  product  on  the  market. 
Again  recently,  our  attention  has  been  brought  to  the 
subject,  and  we  have  repeated  careful  tests  of  the  vegeta- 
ble ferments  as  found  in  the  market.  As  a  result  of  these 
many  tests,  we  have  invariably  found  all  specimens,  papa- 
yotin,  papaine,  papoid,  etc.,  of  such  very  slight  activity  in 
comparison  with  either  pepsin  or  pancreatic  extract,  that 
we  have  always  declined  to  introduce  the  vegetable  prod- 
uct, and  have  never  found  reason  to  undertake  its  manu- 
facture. The  vegetable  ferment  exhibitits  no  new,  peculiar 


30 


or  superior  property  either  as  regards  media  or  character  of 
action.  Considered  as  a  "vegetable  pepsin,"  its  value  must 
rest  upon  its  action  in  acidulated  water,  for  pepsin  has  no 
action  except  in  acid  ;  here  papayotin  or  papoid  is  prac- 
tically inert.  Considered  as  a  ferment  capable  of  action 
comparable  with  trypsin,  its  value  must  rest  on  its  action  in 
neutral  or  alkaline  media  ;  here  it  is  of  very  feeble 
power.  As  a  peptoniser  of  beef,  fibrin,  egg  albumen  o* 
milk,  its  action  is  so  slight  and  unsatisfactory  as  to  be  of 
no  practical  utility.  The  claims  advertised,  that  a  cer- 
tain vegetable  product  acts  in  acid  or  alkali,  in  "  less 
water  "  are  simply  preposterous.  Water  is  essential  to  all 
physiological  action.  The  simplest  tests  under  various 
ranges  of  acidity,  alkalinity,  all  ranges  of  temperature,  of 
proportions  of  water,  will  at  once  show  that  the  "  vegeta- 
ble "  ferment  possesses  no  immunity  from  the  conditions 
governing  all  ferment  action.  The  most  remarkable  thing 
about  the  "vegetable  pepsin"  is  that  its  value  is  in  an 
inverse  ratio  to  the  claims  made  for  it,  and  the  prices 
asked  for  it. 

THE  GASTRIC  FERMENTS. 

PEPSIN. 

Pepsin,  the  peculiar  digestive  principle  of  the  stomach, 
is  active  only  in  the  presence  of  an  acid,  and  most  potent 
with  the  acid  of  normal  gastric  juice  and  with  the  percent- 
age of  free  acid  present  at  the  height  of  gastric 
digestion.  Its  action  is,  however,  by  no  means  in- 
separably associated  with  hydrochloric  acid,  but  it  acts 
freely  with  a  wide  range  of  acidity  with  both  mineral 
and  organic  acids,  lactic,  tartaric,  etc.  Even  the  faintest 
acidity  is  sufficient  to  call  forth  its  action,  which  is 
not  greatly  modified  at  points  either  slightly  above  or 
below  the  free  acid  of  the  normal  media.  Pepsin  digests 
but  one  class  of  substance,  proteids,  all  forms  of  which 


31 


it  is  capable  of  converting  into  peptone.  Various  forms  of 
proteids  show  some  varying  behavior  under  the  influence  of 
the  artificial  gastric  juice.  Coagulated  egg  albumen  goes 
into  solution  from  the  surface  gradually  and  only  upon 
prolonged  contact  does  the  excess  of  albumen  show  any 
notable  softening  effects  or  gelatinous  appearance.  Raw 
fibrin  or  fresh  meat,  instantly  swells  in  contact  with  acidu- 
lated water,  and  then  undergoes  softening  and  solution. 
Boiled  fibrin  or  flesh  behaves  like  boiled  egg  albumen.  If, 
however,  the  raw  albumen  has  been  previously  dissolved  in 
water  and  then  boiled,  we  obtain  a  gelatinous  or  mucilagi- 
nous albumen,  which  upon  contact  with  the  active  ferment 
almost  instantly  becomes  thinner  and  soon  goes  into  com- 
plete solution.  The  ferment  here  behaves  almost  identi- 
cally as  does  diastase  with  gelatinous  starch,  and  the 
resulting  solution  will  contain  various  forms  of  soluble 
albumen  and  peptone,  just  as  the  starch  solution  will 
contain  soluble  starch  and  dextrin.  The  peptic  digestion 
of  albumen  is  a  gradual,  progressive  transformation  into 
peptone,  with  various  intermediate  forms  of  soluble  albu- 
men, the  percentage  of  peptone  depending  greatly  upon 
the  proportion  of  ferment  to  the  albumen  and  the  duration 
of  the  digestion.  Gastric  digestion  ceases  at  peptone  ; 
there  is  no  further  change  or  splitting  up  of  the  peptones 
as  in  the  case  of  pancreatic  digestion.  Pepsin  is  not  only 
inert  in  alkaline  solutions,  but  is  destroyed  with  merely 
sufficient  alkali  (such  as  for  instance,  sodium  bicarbonate,) 
to  give  an  alkaline  reaction.  It  is  not  possible  by  subse- 
quent acidulation  or  any  treatment,  to  bring  the  ferment 
to  show  the  slightest  activity. 

PEPSIN,  ITS  PRACTICAL  USES. 

Pepsin  is  not  available  for  peptonising  food   for  the 
sick,  in  the  household.     Its  action  is  not  only  restricted  to 


32 

albuminous  substances,  but  acid  being  indispensable,  the 
product  is  for  this  reason  unsuitable  as  a  food.  In  the 
laboratory  this  ferment  may  be  and  is  commonly  utilised, 
for  there  the  acids  are  separated  and  the  products  clarified, 
properly.  But  the  terms  "  peptonised  "  and  peptone  are  so 
fixed  in  the  popular  mind  in  association  with  pepsin,  that 
many  continue  to  regard  a  peptonised  food  as  one  made 
with  pepsin  or  containing  pepsin.  Pepsin  is  useless  in  the 
artificial  digestion  of  milk.  Pepsin  cannot  be  used  for  the 
artificial  digestion  of  food  at  the  table  in  the  way  that  the 
Extractum  Pancreatis  may  be.  Pepsin  is,  however,  useful 
for  the  solution  of  fibrinous  membrane,  coagula,  etc.,  and  is 
much  employed  as  a  surgical  resource.  For  its  use  in  this 
direction,  see  "  Surgical  Use  of  the  Digestive  Ferments." 
The  exhibition  of  acid  in  conjunction  with  pepsin  depends 
much  on  circumstances,  for  it  cannot  by  any  means  be 
held  to  be  always  indispensable.  Normal  gastric  juice 
contains  both  free  acid  and  pepsin.  An  artificial  gastric 
juice  for  digestion  in  a  flask,  can  only  be  obtained  by  com- 
bining these  two  agents.  But  the  stomach  cannot  be  dealt 
with  as  with  a  beaker  glass.  We  see  the  good  effects  from 
the  administration  of  pepsin  without  acid  or  in  such  faintly 
acid  solutions  as  Fairchild's  Essence  of  Pepsine.  If  a 
physician  sees  indication  for  the  administration  of  soda,  as 
in  acidity  of  the  stomach,  and  for  pepsin  to  aid  digestion, 
these  two  remedies  may  be  combined  dry  without  regard 
to  the  fact  that  in  an  alkaline  solution  pepsin  is  inert.  For 
it  is  not  supposable  that  an  amount  of  soda  sufficient  to 
impart  an  alkaline  reaction  to  the  entire  gastric  contents 
would  ever  be  given. 

MILK  CURDLING  FERMENT  OF  THE 
GASTRIC  JUICE. 

The  gastric  juice  contains  a  distinct  principle  which  has 
the  power  of  curdling  or  coagulating  milk.     It  is  not  known 


33 


to  have  any  other  property  ;  consequently  it  cannot  be  con- 
sidered a  digestive  ferment  in  the  sense  that  it  effects  any 
change  in  the  constitution  of  an  alimentary  substance. 
Whilst  many  studies  have  been  made  and  theories  advanced 
concerning  the  action  of  this  ferment,  of  the  changes  milk 
undergoes  in  coagulation  by  it,  we  can  only  say  of  this 
ferment  as  of  others,  we  do  not  know  how  it  acts  ;  we  know 
it  to  be  a  true  ferment.  A  solution  of  this  ferment  heated 
to  170°  instantly  loses  all  activity.  Its  action  is  not,  like  that 
of  pepsin  ferment,  dependent  upon  the  intervention  of  an 
acid.  It  curdles  neutral  or  even  faintly  alkaline  milk.  It  may, 
like  pepsin,  be  extracted  by  acidulated  water.  Therefore,  we 
may  obtain  both  ferments  in  an  active,  permanent  solution. 
In  remarkable  contrast  to  pepsin  it  is  not  precipitated  by 
common  salt.  A  brine  extract  is  commonly  employed  in 
the  use  of  "  rennet  "  in  cheese  making.  These  salt  infusions 
of  the  rennet  are  devoid  of  all  peptic  activity.  Pepsin  has 
no  curdling  property,  and  whatever  milk  curdling  action  a 
preparation  of  pepsin  may  show  is  due  entirely  to  the 
true  curdling  ferment  associated  with  it.  Notwithstand- 
ing this  fact,  the  impression  still  obtains  that  pepsin  should 
curdle  milk.  The  question  has  been  raised  as  to  the  value 
or  function  of  this  ferment  in  the  natural  process  of  diges- 
tion, seeing  that  the  gastric  juice  contains  acid  which 
itself,  it  is  said,  should  coagulate  milk.  But  it  is  a  fact  that 
milk  does  not  by  any  means  behave  with  acid  precisely  as 
with  the  curdling  ferment ;  in  the  one  it  is  entirely  a  chem- 
ical change,  in  the  other  a  physiological  change  wrought 
instantly,  and  accompanied  by  no  change  in  the  chemical 
constitution  of  the  caseine.  Further  it  is  of  great  signifi- 
cance, it  seems  to  us,  to  find  that  this  ferment  exists  in  the 
greatest  activity  in  the  stomach  of  the  suckling  animal. 
This  is  so  well  known,  that  it  is  always  the  "  milk  rennet  " 
which  is  used  from  which  to  prepare  rennet  liquids.  The 
stomach  of  the  hog  contains  but  a  trace  of  the  ferment,  and 


34 

pure  pepsin  from  this  source  is  invariably  useless  for 
curdling  milk.  It  would,  therefore,  seem  quite  likely  that 
this  ferment  plays  no  insignificant  part  in  the  digestion  of 
milk.  By  its  action  the  caseine  is  thrown  out  in  the  form  of 
coagula,  most  susceptible  to  the  action  of  the  gastric  juice, 
whilst  the  whey,  containing  the  salts  and  milk  sugar  and 
the  soluble  forms  of  albuminoid,  passes  freely  along  the 
digestive  tract,  where  it  undergoes  assimilation  without  the 
need  of  any  digestive  change.  In  the  young  suckling,  fur- 
thermore, the  pancreas  is  but  partially  developed.  In  this 
curdled  milk  we  see  that  the  caseine  is  reduced  to  a  con- 
dition analogous  to  that  in  which  the  flesh  foods  of  the 
adult  are  presented  to  the  stomach.  If  the  milk  were  not 
curdled,  either  by  acid  or  rennet,  certainly  there  would  be 
no  obstacle  to  the  free  passage  of  the  fluid  milk  along 
the  infant's  digestive  tract.  It  is  not,  then,  without  pur- 
pose, this  curdling  ferment  in  the  stomach  of  the  suckling 
animal. 

The  liquid  rennets  of  the  shops  prepared  from  salted 
vinous  menstruum  do  not  contain  pepsin  and  have  been  so 
inferior  and  variable  in  curdling  activity  that  they  have 
fallen  into  disuse. 


THE    PANCREATIC    FERMENTS. 

TRYPSIN. 
THE  PROTEOLYTIC  FERMENT  OF  THE  PANCREAS. 

The  pancreas  juice  contains  a  principle  which  may  be 
said  to  be  the  analogue  of  pepsin,  in  that  it  is  capable  of 
converting  all  forms  of  proteids  into  peptone.  It  differs 
markedly  from  pepsin  in  important  particulars.  Whilst  it 
is  most  active  in  an  alkaline  solution,  it  is  also  energetic  in 
a  neutral  solution,  and  digests  milk  freely  without  addi- 
tion of  alkali.  Thus,  it  is  not  restricted  in  its  media  to  the 


35 

reaction  characteristic  of  the  fresh  pancreas  juice,  having 
on  the  contrary,  as  will  be  seen,  a  wide  range  of  action. 
Whilst  in  a  feebly  acid  solution,  especially  with  organic 
acids,  it  is  found  to  exhibit  action  upon  fibrin  and  albumen, 
free  hydrochloric  acid  is  far  from  being  favorable  to  tryptic 
action. 

Trypsin  yields  various  soluble  products  and  peptones 
which  do  not  materially  differ  from  those  of  peptic  diges- 
tion, but  unlike  pepsin  it  gives  still  further  normal  prod- 
ucts by  the  transformation  of  peptone  into  leucin  and 
tyrosin. 

Trypsin  has  a  special  affinity  for  the  proteids  of  milk, 
showing  proportionately  more  activity  upon  caseine  than 
upon  other  proteids.  In  the  Extractum  Pancreatis,  trypsin 
is  presented  as  naturally  associated  with  the  other  fer- 
ments of  the  gland.  We  have  also  made  a  special  prepar- 
ation of  trypsin  as  a  solvent  for  diptheritic  membrane. 


THE  DIASTASE  OF  THE  PANCREAS. 

The  starch  digesting  principle  of  the  pancreatic  juice 
presents  no  known  difference  from  the  ferment  of  the 
saliva,  or  of  germinating  grain  (malt)  in  the  media  or 
method  of  its  action,  or  in  the  result  of  its  action.  Like 
every  known  form  of  diastase,  it  gradually  converts  gelati- 
nous starch  into  soluble  starch,  dextrines,  glucose  or  malt 
sugar.  It  is  active  in  neutral  or  alkaline  reactions.  We 
cannot  therefore,  distinguish  one  form  of  diastase  from 
another  merely  by  its  behavior,  and  whatever  views  may 
be  held  regarding  diastase  as  a  remedy,  must  apply  to 
this  ferment  from  whatever  source  it  appears.  We  have 
no  means  of  knowing  definitely  to  what  degree  of  con- 
version starch  is  carried  in  the  natural  process  of  diges- 


36 

tion,  but  there  is  no  doubt  that  its  complete  transfor- 
mation into  glucose  is  not  essential  to  its  assimilation  ; 
physiological  experiments  show  that  the  highly  diffusible 
dextrines  and  soluble  starches  are  absorbed  into  the 
blood,  and  there  is  every  ground  to  suppose  that  a  very 
considerable  portion  of  the  products  of  starch  digestion 
are  absorbed  long  before  they  could  reach  their  ultimate 
conversion.  The  influences  of  various  substances  upon 
diastase  are,  as  in  the  case  of  all  ferments,  largely  mod- 
ified by  the  proportion  of  ferment  and  by  the  presence  of 
products  of  digestion,  etc.,  so  that,  whilst  in  the  labora- 
tory we  fix  the  retarding  influence  of  definite  percentages 
of  acids  or  of  alkali  under  arbitrary  conditions,  we  must 
not  overlook  the  insufficiency  of  such  data  as  bearing  upon 
the  actual  conditions  of  digestion  within  the  body. 

The  incompatibility  of  acid  and  diastase  does  not  afford 
sufficient  ground  for  the  assumption  that  the  starch  digest- 
ing principle  finds  no  field  for  action  in  the  stomach.  The 
gastric  juice  is  absolutely  inert  upon  starch  ;  the  major 
part  of  farinaceous  matter  is  in  a  form  incapable  of  solu- 
tion during  the  short  contact  with  the  salivary  diastase  in 
the  mouth  ;  the  stomach  contents  have  at  the  outset  of 
normal  digestion  but  a  feebly  acid  reaction,  and  the  acidity 
only  reaches  its  maximum  point  an  hour  or  so  after  the 
ingestion  of  food.  In  view  of  all  these  facts,  the  conclu- 
sion is  reasonable,  that  the  stomach  affords  opportunity  for 
such  preliminary  digestion  of  starch  as  fits  it  for  further 
conversion  in  the  intestinal  tract. 


USES  OF  PANCREATIC  DIASTASE. 

The  practical  identity  of  the  pancreatic  and  salivary 
diastase  being  established,  it  follows  that  we  may  as 
reasonably  exhibit  an  active  extract  of  the  pancreas  in 


37 

deficiency  of  salivary  digestion,  as  we  may  exhibit  pepsin 
in  feeble  gastric  digestion. 

The  most  rational  way  of  supplementing  deficient  sali- 
vary digestion  is  to  add  the  active  pancreatic  preparation 
to  farinaceous  food  at  the  table.  No  taste  is  imparted  to 
the  food,  no  suggestion  whatever  of  "  medicine,"  and  under 
its  influence  the  starch  is  rapidly  softened,  and  converted 
into  a  soluble  form  which  will  insure  its  proper  digestion. 
For  children  and  the  aged  and  convalescent,  this  method  is 
especially  recommended.  For  faulty  intestinal  digestion  of 
starch,  the  Extractum  Pancreatis  or  DiastasicEssence  should 
be  given  immediately  after  meals,  and  repeated  in  an  hour 
or  two.  In  the  Extractum  Pancreatis  the  starch  digesting 
principle  is  accompanied  with  ferments  which  digest  air 
other  forms  of  aliment,  and  which  are  often  indicated  in 
connection  with  diastase.  In  the  Diastasic  Essence  of 
Pancreas,  the  starch  digesting  principle  is  presented  in 
an  exceedingly  active,  agreeable  and  practically  isolated 
form,  and  it,  therefore,  may  be  advantageously  resorted  to 
in  cases  where  it  is  not  desired  to  adminster  the  other  fer- 
ments of  digestion.  For  intestinal  indigestion  of  starch,  the 
diastasic  ferment  may  best  be  given  just  previous  to  taking 
food,  and  again  about  two  hours  after  food.  The  diastasic 
ferment  given  just  previous  to  or  with  meals  promotes 
the  preliminary  starch  digestion,  that  which  is  normally 
effected  by  the  salivary  diastase  ;  given  after  the  force 
of  gastric  digestion  is  lessened,  it  promotes  the  secondary 
or  pancreatic  digestion  of  starch.  The  Pancreatic  Tab- 
lets and  the  Diastasic  Essence  are  especially  commended 
as  a  means  of  exhibiting  this  ferment. 

THE  EMULSIVE  FERMENT. 

The  characteristic  action  of  the  emulsive  ferment  is  the 
conversion  of  oils  or  fats  into  a  minute  state  of  division  or 


38 

emulsification.  The  emulsification  and  absorption  of  the 
minutely  divided  molecules  are  successive  steps,  precisely  as 
the  conversion  or  hydration  of  albumen  is  antecedent  to  its 
absorption.  Whether  there  is  also  any  chemical  change  in 
the  fat  by  action  of  the  ferment,  may  be  said  to  be  a  moot 
question.  If  a  fat  or  oil  is  macerated  for  some  hours  at 
the  temperature  of  the  body  with  fresh  pancreas  juice  or 
with  minced  pancreas  and  then  strained,  it  will  be  found 
that  the  pancreatised  fat  will  instantly  form  a  thick,  creamy 
emulsion  when  shaken  with  an  equal  quantity  of  water. 
The  pancreatic  juice  when  taken  from  the  gland  soon  under- 
goes change  and  shows  an  acid  reaction,  and  it  has  been 
asserted  that  when  the  development  of  these  fatty  acids  is 
prevented,  there  is  no  occurence  of  these  acids  in  the 
treatment  of  fat  under  the  influence  of  the  emulsive  fer- 
ment. As  the  chief  and  characteristic  behavior  is  the 
breaking  up  of  the  fat  into  emulsion  or  creamy  form, 
so  doubtless  is  the  greater  part  of,  fat  assimilated 
direct  without  undergoing  any  conversion.  It  is  a 
curious  fact  that  this,  the  least  available  and  the  least 
practically  important  pancreas  ferment,  has  been  the 
one  to  which  attention  had  been  chiefly  directed  prior 
to  the  introduction  of  the  Extractum  Pancreatis. 
The  "  pancreatines "  found  in  commerce  bore  no 
other  reference  to  any  digestive  action  or  use  than 
their  asserted  property  of  emulsifying  cod  liver  oil, 
whilst  they  were  completely  deficient  in  the  other  fer- 
ments of  the  gland.  The  emulsive  ferment  is  not 
capable  of  effecting  the  permanent  admixture  of  oil 
with  water,  as  may  be  done  by  purely  mechanical 
agents,  such  as  gums,  etc.  The  pancreatic  liquors, 
as  well  as  the  commercial  pancreatine,  are  of  only 
the  slightest  emulsive  value.  The  Extractum  Pan- 
creatis is  in  this,  as  in  other  ferments  of  the  gland, 


39 


the  most  active  product.  If  a  few  grains  of  the  Ex- 
tractum  Pancreatis  be  well  shaken  with  one  or  two 
drachms  of  warm  water,  and  an  ounce  of  cod  liver  oil  or 
pure  olive  oil,  and  allowed  to  stand  in  a  warm  place  for 
five  or  six  hours,  it  will  be  found  that  this  oil  will  then 
form  a  creamy  emulsion  with  water  ;  upon  standing,  this 
emulsion  will  gradually  separate,  but  may  again  be  emul- 
sified by  agitation.  When  the  use  of  the  gummy  and 
starchy,  sweet  emulsions  are  contra-indicated,  The  Ex- 
tractum  Pancreatis  may  be  utilised  as  already  described, 
or  it  may  be  given  immediately  after  the  pure  oil  or  the 
usual  emulsions. 

THE  MILK  CURDLING  FERMENT  OF  THE 
PANCREAS. 

The  pancreas  contains  a  ferment  which  curdles  milk 
slightly  acid,  neutral  or  alkaline.  As  associated  with  the 
other  ferments  of  the  pancreatic  juice  or  in  an  active 
extract  of  the  pancreas,  such  as  Fairchild's  Extractum 
Pancreatis,  it  cannot  be  practically  utilised  in  the  same 
manner  as  the  rennet  ferment  in  the  preparation  of  curds 
and  whey.  The  proteolytic  ferment  will  attack  the  curded 
caseine  and  soon  dissolve  it. 

If  a  few  (five)  grains  of  Extractum  Pancreatis  be 
added  to  pure  lukewarm  milk  (say  four  ounces),  a  soft 
curd  will  be  almost  instantly  formed.  If  the  milk  is 
permitted  to  stand  at  rest,  the  curd  will  not  cohere  and 
separate  in  a  mass  from  the  whey  as  in  rennet  curdling, 
but  will  gradually  become  softer,  will  float  in  the  milk 
and  finally  disappear.  If  the  milk  is  stirred  with  a 
rod  or  spoon,  the  curd  is  instantly  broken  up  into 
minute  particles  suspended  in  the  milk,  and  soon  under- 


40 

goes  digestion,  the  milk  acquiring  the  characteristic  color 
and  taste  of  peptonisation. 

THE  DOSAGE  OF  DIGESTIVE  FERMENTS. 

The  digestive  ferments  having  no  drug  action,  no 
property  comparable  to  that  by  which  the  doses  of 
remedial  agents  are  in  general  regulated,  a  small  dose 
differs  from  a  large  dose  only  in  degree,  not  in  character  of 
effect  produced.  There  is  no  such  relation  of  effect  to  dose 
as  in  the  case  of  drugs,  such  as  ipecac,  calomel,  strych- 
nine, etc.  We  cannot  expect,  therefore,  to  fix  any 
arbitrary  range  of  dose  as  with  drugs  with  distinct 
measurable  action  upon  the  body.  In  the  days  of  the 
saccharated  pepsins  and  pancreatines,  large  bulk  with  minute 
quantities  of  true  ferment  were  given  ;  with  the  introduc- 
tion of  Fairchild's  preparations  of  unprecedented  activity,  a 
few  grains  became  the  generally  employed  dose,  and  the 
tendency  seems  to  be,  as  these  products  are  more  and 
more  improved  in  potency,  that  the  doses  are  rather  dimin- 
ished. Doubtless  there  has  obtained  in  the  past  some 
impression  that  large  doses  of  pure  ferments  might  not  be 
harmless  ;  but  neither  in  medical  literature  nor  in  anything 
that  we  know  of  the  physiology  of  digestion,  nor  from  the 
extended  opportunity  for  learning  the  results  of  the  practi- 
cal use  of  the  digestive  ferments,  does  there  appear  any 
tenable  ground  for  this  assumption.  It  has  existed  only 
as  a  vague  theory,  and  as  a  surmise  of  possibilities.  The 
animal  digestive  ferments  find  a  place  in  materia  medica, 
because  they  display  upon  food  substances  under  con- 
ditions closely  conformable  in  temperature  and  in  reaction 
to  those  of  the  body,  the  action  characteristic  of  the  normal 
digestive  secretions.  Properly  introduced  into  the  living 
digestive  tract,  we  may  then  expect  that  they  will  exert 
precisely  the  same  effects  as  the  naturally  secreted 


ferment.  A  large  dose  of  pepsin  artificially  introduced 
into  the  process  of  digestion  can  no  more  attack  the 
stomach  membrane  than  will  the  natural  gastric  juice. 
The  sufficient  dose  to  supplement  deficient  digestion 
must  vary  largely  and  the  dose  need  only  be  reg- 
ulated by  considerations  of  the  amount  required  to  effect 
the  purpose.  That  habitual  use  of  a  ferment  may  rationally 
be  resorted  to,  in  order  to  produce  tranquil  digestion  for 
those  patients  whose  digestion  is  susceptible  to  disorder,  or 
impaired  by  care,  anxiety  and  sedentary  occupation  and 
similiar  influences  is  beyond  question.  What  expedient 
more  practical  or  innocent  ?  Certainly  far  less  likely  to  be 
harmful,  than  persistent  "  drugging." 

THE     FAIRCHILD     PREPARATIONS 

OF    THE 

DIGESTIVE    FERMENTS. 

The  uniform  character,  activity  and  reputation,  of 
the  Fairchild  Preparations  of  Digestive  Ferments  are 
sufficient  evidence,  of  the  fallacy  of  the  statements 
sometimes  advanced,  that  the  digestive  ferments  are 
necessarily  variable  and  unreliable  agents.  The  fact 
is  that  Fairchild's  digestive  ferments  are  second  only 
in  uniformity  to  the  alkaloids  and  chemicals.  They 
are  more  definite  and  uniformly  reliable  than  most 
drugs,  or  galenical  preparations  therefrom, — extracts, 
tinctures,  etc.  The  status  of  these  preparations  of  the 
digestive  ferments,  moreover,  does  not  depend  simply 
upon  medicinal  properties,  so  difficult  to  determine  for 
all  agents  except  those  which  have  a  distinct  action  upon 
the  body.  They  are  valued  for  reason  of  definite 
demonstrated  and  applied  digestive  properties. 


42 

The  Fairchild  special  products  have  been  put  for- 
ward with  definite  methods  for  accomplishing  certain 
practical  results.  As  a  record  of  more  than  ten  years  of 
experience,  not  an  instance  has  occured  where  one  of  our 
preparations  has  failed  to  perform  this  work — has  disap- 
pointed the  anticipation  of  the  physician.  Not  a  package 
of  the  Extractum  Pancreatis  nor  a  Peptonising  Tube  has 
proven  inert  upon  milk  or  starch.  The  surgeon  who  sees 
the  potent  solvent  action,  of  Fairchild's  pepsin  upon 
morbid  tissue  ;  the  physician  who  sees  the  absolute 
certainty  with  which  the  Extractum  Pancreatis  may 
be  applied  in  peptonising  milk,  etc.,  will  not  doubt  these 
agents  possess  substantial  claims  to  therapeutic  use. 

The  Fairchild  preparations  are  the  result  of  original 
special  work  given  to  the  digestive  ferments.  Each  and 
every  product  offered  to  the  medical  profession  has  been 
carefully  prepared  to  meet  certain  requirements  and  to 
fulfill  a  definite  purpose. 

We  have  especially  sought  to  avoid  all  incompatible 
compounds,  and  do  not  supply  these  even  if  having  popu- 
lar sale,  and  we  do  not  needlessly  multiply  the  variety  of 
preparations.  For  all  the  important  purposes  for  which 
the  digestive  ferments  are  now  applied,  the  Fairchild 
preparations  have  been  either  originated,  or  been  the 
means  employed,  on  account  of  their  well-known 
superiority. 

The  commercial  products  of  the  digestive  ferments  will 
differ  in  character,  in  grade  of  activity,  in  purity,  according 
to  the  skill,  knowledge,  and  purpose  of  the  manufacturer. 
Some  are  made  to  supply  a  demand  for  cheap  preparations  ; 
others  to  imitate  in  physical  characteristics  products  which 
have  become  eminent  for  value. 


43 

The  Fairchild  preparations  being  almost  exclusively 
dispensed  upon  the  prescription  of  the  physicians,  we 
have  with  a  due  regard  to  the  interest  and  convenience  of 
the  pharmacist,  supplied  them  in  bulk  whenever  practica- 
ble. This  fact  has,  however,  only  afforded  better  oppor- 
tunities to  that  class  of  manufacturers  who  find  it 
impossible  to  make  a  market  for  their  goods  on  the  score 
of  merit,  but  who,  as  in  every  "  line,"  prefer  to  trade 
upon  the  reputation  of  standard  products  by  the  substitu- 
tion of  inferior  and  "  cheap  "  imitations.  These  inferior 
products  are  urged  upon  the  pharmacists  as  the  "  same 
thing,"  "  gives  you  extra  profit  ;"  if  "  Fairchild's  is  not 
specified,  use  ours  ;"  although  it  is  plain  that  the  physi- 
cian even  when  not  specifying  Fairchild's  really  means 
and  expects  to  get  Fairchild's,  owing  to  his  long  reliance 
upon  them  years  before  the  appearance  of  so  many  prepa- 
rations under  the  same  titles. 

Owing  to  the  great  reputation  and  use  of  Fairchild's 
Essence  of  Pepsine,  this  preparation  has  been  the  especial 
object  of  imitation. 

The  title,  Essence  of  Pepsin,  has  been  applied  to 
preparations  entirely  dissimilar  and  inferior  in  properties 
to  the  original  Essence  of  Pepsine. 

In  many  instances,  upon  complaint  of  physicians,  we 
have  examined  these  dishonest  imitations  which  have 
been  substituted  even  when  Fairchild's  is  specified,  and 
found  them  often  inert  upon  milk,  of  weak  peptic  power 
and  of  a  distinctly  unpalatable  character.  In  view  of  the 
very  important  properties  and  uses  of  this  Essence  as  a 
means  of  administering  drugs,  preparing  whey,  etc.,  to 
correct  digestive  disorders  of  infancy,  the  substitution 
of  these  worse  than  useless  preparations  Inflicts  serious  in- 
jury— injury  upon  the  patient,  the  physician,  and  the 


44 

manufacturer  upon  whom  the  physician  relies.  Further 
the  same  price  is  charged  the  customer  as  for  the  original 
article — which  leaves  no  question  as  to  the  real  purpose 
of  this  infamous  practice.  We  desire  to  take  this  occasion 
to  say  that  in  contrast  to  this,  the  great  body  of  pharma- 
cists not  only  religiously  regard  the  wishes  of  the  pre- 
scriber,  but  many  of  them,  we  are  glad  to  know  dispense, 
and  use  generally,  Fairchild's  preparations  by  their  own 
preference.  Seeking  no  other  market  than  that  caused 
by  the  preference  for  Fairchild's  preparations,  we  desire  to 
protect  ourselves,  the  physician  and  his  patient,  from  the 
substitutes  and  imitations.  We,  therefore,  ask  the  "favor, 
that  the  physician  will  distinctly  specify  Fairchild's  when 
he  wishes  them,  and  in  case  of  any  dissatisfaction  that  he 
will  send  to  us  for  examination  the  preparation  dispensed. 

FAIRCHILD'S    PEPSIN. 
IN  SCALES  AND  POWDER. 

Fairchild's  pepsin  conforms  in  all  particulars  to  the  re- 
quirements of  the  U.  S.  Pharmacopoeia,  in  activity,  solu- 
bility, and  physical  properties.  It  is  freely  soluble,  perma- 
nent, free  from  disagreeable  odor  and  taste.  One  grain 
will  digest  3000  grains  of  albumen  according  to  the  officinal 
method  of  valuation. 

As  the  originators  of  "  Pepsin  in  Scales,"  we  deem  it  a 
matter  for  congratulation  that  "pepsin  "  is  now,  for  the  first 
time,  officinal,  and  thus  placed  where  it  obviously  long  ago 
should  have  been,  among  the  recognised  therapeutic  agents 
of  the  Materia  Medica.  Hitherto,  owing  to  the  fact  that 
there  has  been  no  officinal  and  mandatory  standard  of  value, 
there  have  been  many  very  inferior  and  often  worthless 
products  sold  and  dispensed  as  "  pepsin."  The  saccharated 


45 


having  been  the  only  officinal  preparation,  absurdly  weals 
doses  of  the  ferment  itself  have  too  often  been  used. 
There  is  every  reason  to  believe  that  pepsin  will  in- 
crease in  reputation  as  a  therapeutic  agent,  now  that  it 
is  obligatory  to  dispense  a  preparation  of  i  to  3000 
strength. 

In  order  to  obtain  the  best  results  and  to  insure  a 
uniformly  excellent  product,  the  physician  is  requested  to 
prescribe  "Fairchild's"  pepsin. 


SACCHARATED    PEPSIN. 

The  saccharated  was  for  years  the  best  known  and  most 
used  form  of  pepsin.  The  original  standard  of  strength 
was  that  10  grains  should  digest  about  150  grains  of  albu- 
men. In  the  1880  revision  of  the  Pharmacopoeia,  it  was 
made  the  first  and  only  officinal  form  of  dry  pepsin,  and  it 
was  required  that  i  grain  should  digest  50  grains  of 
albumen.  According  to  the  new  Pharmacopoeia  (1890) 
saccharated  pepsin  must  contain  10  per  cent,  of  a  i  to  3000 
pepsin  and  90  per  cent,  of  milk  sugar — i  grain  of  this  to 
digest  300  grains  albumen.  In  view  of  the  facility  with 
which  Fairchild's  pepsin  can  be  mixed  with  milk  sugar  to 
any  desired  dosage,  there  seems  little  use  for  "  Saccharated 
Pepsin,"  except  to  give  a  reasonable,  definite  standard  for 
a  product  hitherto  of  but  little  value.  Fairchild's  Sacchar- 
ated Pepsin  conforms  fully  to  the  Pharmacopoeia  require- 
ments. 


46 

GLYCERINUM  PEPTICUM. 
(FAIRCHILD.) 

Glycerin  possesses  peculiar  value  as  at  once  an  extrac- 
tive and  preservative  of  the  digestive  ferments.  For  this 
purpose  it  has  long  been  used  in  the  physiological  labora- 
tory and  the  glycerin  extracts  have  been  preferred  for  ex- 
perimental purposes.  Fairchild's  Glycerinum  Pepticum  is 
the  first  commercial  product  in  which  glycerin  has 
been  utilised  to  prepare  a  concentrated,  stable  solution  of 
pepsin,  direct  from  the  mucous  membrane.  This  Glyceri- 
num Pepticum  presents  the  peptic  ferment  in  the  most 
isolated  form  in  which  it  has  ever  been  produced  in  solu- 
tion for  practical  purposes,  containing  no  alcohol,  sugar, 
flavoring  or  antiseptic  other  than  the  pure  glycerin.  It  is 
a  clear,  bright  extract,  remarkably  free  from  color,  odor 
or  taste,  freely  soluble  without  cloudiness  in  all  proper 
menstrua  or  media.  It  is  notably  devoid  of  the  peculiar 
disagreeable  characteristics  of  the  glyceroles  of  peptone 
pepsin.  It  is  by  far  the  most  convenient  and  useful  for 
all  purposes  where  pure  pepsin  is  required  in  solution  ;  for 
extemporaneous  mixtures,  for  experimental  purposes,  for 
applying  pepsin  as  a  surgical  solvent,  for  preparing  offici- 
nal solutions.  It  is  quite  agreeable,  even  in  pure  or  acidu- 
lated water  and  may  be  given  in  wines,  elixirs,  etc.  It 
is  especially  convenient  for  the  physician  who  finds  it 
desirable  to  dispense  medicines  and  for  hospitals  and 
dispensaries.  For  the  manufacture  of  all  the  usual  pep- 
sin fluids,  wines,  elixirs,  liquors,  etc.,  it  is  far  preferable, 
gives  a  more  stable  and  agreeable  preparation  than  ob- 
tainable by  any  other  form  of  soluble  pepsin.  Twelve 
minims  are  capable  of  digesting  2,000  grains  albumen 
under  usual  conditions. 


47 

ESSENCE  OF  PEPSINE, 
(FAIRCHILD.) 

A  SOLUTION  OF  THE  ESSENTIAL  ORGANIC  INGREDIENTS  Of 

THE  GASTRIC  JUICE,  EXTRACTED  DIRECTLY  FROM 

THE  PEPTIC  GLANDS  OF  THE  STOMACH. 

Fairchild's  Essence  of  Pepsine  is  obtained  by  direct 
extraction  from  the  fresh  calf  rennet  in  a  menstruum 
which  possesses,  in  the  highest  degree,  the  properties  of  a 
vehicle  and  a  preservative  of  the  peptic  and  the  milk 
curdling  ferment. 

The  Essence  of  Pepsine  is  a  remarkably  agreeable, 
diffusible,  aromatic  stimulant ;  yet  holds  in  solution  both 
the  active  ferments  of  the  fresh  gastric  juice.  It  is  but 
faintly  acid,  not  in  the  least  heavy  with  sweet,  leaves  upon 
the  palate  not  the  least  pronounced  impression  of  any  pre- 
dominant flavoring.  It  is  free  from  all  suggestion  of 
animal  origin,  and  further,  imparts  a  delicate  flavor  and 
aroma  to  milk-curd  or  junket,  whey  and  cold  milk. 

Pepsin,  like  many  another  remedy,  gains  by  judicious 
association  of  corrigents,  and  only  second  to  the  actual 
agents  of  digestion  are  the  aromatics  skillfully  combined. 
The  salutary  influence  of  savory  substances  and  the  re- 
markably malevolent  effect  of  some  discordant  flavor 
are  common  experiences  even  in  health  ;  dyspeptics  are 
especially  sensitive  to  digestive  disturbances  out  of  all 
proportion  to  the  apparent  cause.  The  usual  pharma- 
ceutical preparations,  the  elixirs,  wines,  cordials,  and  so 
forth,  are  generally  poor  examples  of  what  a  blend  of 
proper  aromatics  should  be.  Many  of  these  preparations, 
produced  in  imitation  of  Fairchild's  Essence,  are  so  dis- 
tasteful as  to  greatly  militate  against  the  good  effects  which 
might  be  derived  from  any  ferment  they  may  contain. 

Fairchild's  Essence  of  Pepsine  has  long  been  the  most 


48 

Useful  and  successful  of  all  pepsin  preparations.  It  is 
found  of  peculiar  value  for  three  distinct  purposes — as  a 
remedy  for  indigestion  in  adults  and  infants  ;  as  a  means 
of  administering  drugs  which  disturb  the  digestive  func- 
tions and  impair  the  appetite  ;  as  a  practical  rennet  agent. 

For  infantile  digestive  disorders  Fairchild's  Essence  of 
Pepsine  is  especially  effective  ;  it  not  only  aids  digestion, 
but  corrects  flatulency  and  vomiting.  It  is,  therefore, 
far  more  innocent  and  effective  than  the  usual  domestic 
and  empirical  remedies  for  colic,  etc.  ;  certainly  in- 
finitely preferable  to  soothing  cordials.  In  cholera  infantum 
it  presents  the  most,  valuable  properties — stimulant,  car- 
minative, and  digestive,  and  is  far  better  than  alcoholic 
stimulants,  per  se.  For  persons  of  habitually  weak  diges- 
tion it  proves  the  most  acceptable  and  potent  resource. 

The  usual  dose  for  an  infant  is  from  5  to  10  drops,  and 
from  i  to  3  teaspoonfuls  for  an  adult. 

That  Essence  of  Pepsine  is  of  great  service  in  aiding 
the  tolerance  of  drugs  sucli  as  iodides,  bromides,  mercur- 
ials, etc.,  is  well  known.  Here  it  is  not  only  important  to 
give  pepsin,  but  the  ferment  must  be  in  such  a  form  as  to 
overcome  the  repulsion  caused  by  the  ingestion  of  these 
drugs.  The  Essence  of  Pepsine  has  proven  of  the  greatest 
possible  service  in  the  administration  of  such  drugs,  be- 
cause of  its  digestive  and  grateful  stomachic  properties. 
It  is  confidently  relied  upon  for  this  purpose  by  many  phy- 
sicians. As  a  vehicle  simply,  the  Essence  is  by  far  the 
best  in  use.  Drugs  which  give  unsightly  mixtures  or 
which  completely  overcome  the  agreeable  qualities  of  the 
Essence  should  be  given  in  separate  form,  to  be  immedi- 
ately followed  by  one  or  two  teaspoonfuls  of  the  pure 
Essence,  thus  gaining  the  greatest  advantage  of  its 
agreeable  qualities. 

The  efficacy  of  the  Fairchild's  Essence  for  administering 


49 

iodide  of  potash  and  the  certainty  with  which  the  Essence 
is  used  in  making  milk  curd  or  junket,  has  led  to  the  suc- 
cessful experiment  of  using  this  essence  junket  itself  as  a 
vehicle  for  the  iodide  of  potash.  The  method  of  preparing 
this  medicated  junket  is  given  on  page  50. 

Further  practical  uses  of  Essence  of  Pepsine  in  prepar- 
ing whey,  junket,  etc.,  as  food  for  invalids  and  in  cholera 
infantum,  are  given  in  Practical  Recipes. 

Fairchild's  Essence  of  Pepsine  was  the  first  medicinal 
preparation  ever  offered  of  the  two  gastric  ferments,  peptic 
and  milk  curdling.  This  pharmaceutical  product  from 
the  fresh  stomachs  has  only  been  obtained  by  many  years 
of  experience  and  skill,  and  utmost  care  and  nicety  in 
manipulation. 

The  wine  and  elixir  of  pepsin  obtained  as  they  have 
been,  by  dissolving  absurdly  small  proportions  of  sacchar- 
ated  or  other  pig  pepsins  in  wine,  etc.,  are  practically  use- 
less. The  more  recent  class  of  "  essences,"  etc.,  made  in 
imitation  of  Fairchild's,  to  fill  the  prescriptions  for  Essence 
where  Fairchild's  is  not  actually  specified,  are  greatly 
inferior  in  every  respect  to  the  original  Essence  of  Pepsine. 
They  are  obviously  made  from  peptone  pepsins  dissolved 
in  "  elixir  bodies,"  are  inferior  in  every  important  respect, 
quality,  flavor,  pepsin  and  rennet  action.  Many  physicians 
who  have  for  ten  years  and  more  used  Fairchild's  Essence, 
naturally  expect  thie  will  be  dispensed  when  they  order 
Essence  of  Pepsine,  but  it  is  now  very  important  to  specify 
Fairchild's.  The  substitutes  cost  the  patient  the  same  price 
as  the  genuine. 

MEDICATED    JUNKET. 

JUNKET    WITH    POTASSIUM    IODIDE,  MERCURIALS,  ETC. 

The  use  of  junket  as  a  vehicle  for  the  exhibition  of 
iodide  of  potash  was  first  suggested  by  Dr.  D.  Bryson 


50 

Delavan  of  New  York,  in  a  paper  which  appeared  in  the 
New  York  Medical  Record,  Nov.  28th,  1891.  Dr.  Dela- 
van found  by  dissolving  the  iodide  in  Fairchild's  Essence 
of  Pepsine,  and  adding  this  to  a  small  quantity  of  warm 
milk,  that  the  curd  which  was  instantly  formed  completely 
enveloped  the  salt  in  a  thoroughly  diffused  form,  and  gave 
no  taste  or  suggestion  of  its  presence.  It  was  found  by 
this  writer  that  the  iodide  could  thus  be  freely  adminis- 
tered without  the  disturbance  of  digestion  so  character- 
istic of  this  most  distinctly  repulsive  chemical. 

Subsequently  we  tried  Fairchild's  Essence  of  Pepsine, 
used  in  the  manner  suggested,  in  preparing  junket  with 
Potassium  Bromide,  Sodium  Salicylate,  Iodide  of  Potash 
with  Biniodide  Mercury,  Chloral  Hydrate,  etc.,  and  with  all 
these  found  the  Essence  to  at  once  yield  an  agreeable, 
jelly-like  curd.  We  have  in  this  junket,  as  prepared  with 
Fairchild's  Essence  of  Pepsine,  a  distinct  acquisition  to  our 
means  of  administering  a  class  of  drugs  which  it  is  of  the 
utmost  importance  to  be  able  to  give  in  a  form  which  does 
not  disturb  the  stomach.  Wherever  it  is  desirable,  this 
junket  may  be  used  to  convey  the  iodide,  mercurials,  etc., 
without  the  knowledge  of  the  patient  as  to  its  medicinal 
character.  This  is  the  formula  best  adapted  for  prescrip- 
tion : 

!£     Potassium  Iodide f  3  ii. 

Essence  of  Pepsine,  Fairchild's f  §  iii. 

Add  one  teaspoonful  to  a  wine-glas«  of  warm  milk,  and 
take  the  resulting  curd  (after  meals,  or  at  such  times  as 
desired  to  order  it).  From  5  to  10  grains  Salicylate  Soda, 
or  Potassium  Iodide,  with  ^  to  £  grain  Mercury  Biniodide, 
may  be  ordered  to  each  fluid  drachm  of  the  Fairchild's 
Essence. 


51 

PEPSIN  TESTING. 

Notwithstanding  the  immense  study  which  has  been 
given  to  pepsin,  no  satisfactory  chemical  test  for  it  has 
ever  been  established.  The  more  we  learn  about  the 
digestive  ferments,  the  stronger  becomes  the  conclusion 
that  they  are  all  some  form  of  albuminoid  matter,  as  they 
are  themselves  the  product  of  albuminoid  cells.  A  chem- 
ical test  for  pepsin  must  be  one  very  sharply  distinguished 
from  all  other  reaction  of  albuminoids;  must  be  the  unmis- 
takable evidence  of  the  living  ferment.  For  a  ferment 
may  have  been  subjected  to  influences  which  have  quite 
destroyed  its  activity  and  not  appreciably  altered  its 
physical  or  chemical  characteristics.  Whilst  we  may  dis- 
cover some  peculiar  reaction  for  pepsin,  it  is  scarcely 
possible  that  we  can  ever  assay  pepsin  by  chemical  analysis. 
As  pepsin  appears  in  commerce,  the  ferment  is  associated 
with  substances  readily  distinguished,  such  as  common  salt, 
milk  sugar,  hydrochloric  acid  and  starch.  If  these  are  in 
obviously  large  proportion,  the  inference  will  be  that  the 
products  are  weak,  yet  this  is  by  no  means  certain,  for  a 
saccharated  pepsin  may  prove  more  active  than  a  so-called 
"  pure  pepsin,"  in  which  the  ferment  is  either  injured  in  the 
process  of  manufacturing,  or  presented  in  a  very  large 
proportion  of  gelatin,  albumen,  or  peptones.  The  peptone  is 
the  product  of  the  self-digestion  of  the  lining  membrane  in 
acidulated  water  with  heat ;  the  ferment  thus  dissolves  the 
proteid  matter  in  which  it  is  secreted,  or  which  maybe  added, 
just  as  diastase  dissolves  the  starch  in  the  germinated  barley 
or  malt.  There  is  thus  a  distinct  analogy  between  maltose 
(malt  extract)  containing  free  diastase,  and  peptone  contain- 
ing free  pepsin.  The  peptone  is  objectionable  to  just  that 
degree  that  it  dilutes  the  pepsin,  renders  it  hygroscopic  and 


52 

prone  to  spoil.  The  chemical  treatment,  the  condensation 
by  heat  of  the  peptone  solution  to  a  scaling  consistence  may 
account  for  the  great  variation  in  activity  of  some  of  these 
products  possessing  practically  identical  physical  prop- 
erties. At  present  we  can  only  test  pepsin  by  its  action  on 
albuminous  matter  in  acidulated  water.  The  form  of  albu- 
men most  uniform,  convenient  and  satisfactory  is  the 
white  of  egg.  It  is  but  a  few  minutes'  work  to  form 
some  opinion  of  any  brand  or  specimen  of  pepsin,  by  ascer- 
taining if  it  has  any  marked  action  on  gelatinous  egg 
albumen  in  warm  acidulated  water.  Gelatinous  albumen, 
made  by  dissolving  fresh  white  of  egg  in  cold  water  and 
boiling  well  and  adding  the  acid,  digests  much  more  rapidly 
than  coagulated  albumen.  It  forms  a  thick,  opaque  muci- 
lage, very  similar  to  gelatinous  starch  and  behaves  with 
pepsin  just  as  gelatinous  starch  does  with  diastase  ;  the 
active  ferment  converting  it  instantly  into  a  thin,  watery 
solution.  Thus  the  physician  or  pharmacist  can  at  least 
readily  discover  an  inert  or  worthless  product.  To  determine 
the  actual  digestive  power  of  any  product,  it  is  necessary  to 
test  it  upon  albumen  under  definite  conditions  well  known 
to  be  favorable  to  the  action  of  the  ferment,  employing  a 
sufficient  quantity  of  albumen  to  leave  such  an  excess  as  to 
make  sure  that  the  ferment  has  exhausted  its  activity.  There 
is  a  very  important  relation  between  the  proportion  of  acid, 
water  and  albumen.  This  should  be  so  adjusted  as  to  give  a 
definite,  proper  percentage  of  free  acid  in  the  mixture.  The 
albumen  alkali  neutralises  a  certain  amount  of  the  acid  ;  the 
acid  forms  certain  combinations  with  the  albumen  at 
various  stages  of  digestion.  A  test  mixture  may  appear  to 
have  less  acid  than  another,  yet  have  more  acid,  owing  to 
the  small  proportion  of  albumen  to  acidulated  water  and 
vice  versa.  The  parts  of  acid  to  parts  of  water  must  then 
be  regulated  according  to  the  proportion  of  albumen  to 


53 

acidulated  water.  In  tests  adjusted  to  start  with  ex- 
actly parallel  quantities  of  ferment  and  albumen  and 
acid,  the  results  will  vary  with  the  volume  of  water. 
The  larger  the  proportion  of  water  within  limits, 
the  more  digestion ;  with  too  little  water  the  fluid 
soon  becomes  clogged  with  the  products  of  diges- 
tion. The  acid  hydrochloric  U.  S.  P.  of  commerce 
varies  in  percentage  of  absolute  acid.  Therefore  it  is  well 
to  employ  acid  of  a  known  strength  and  to  use  the  same 
specimen  of  acid  in  a  series  of  experiments.  The  quantity 
of  albumen  necessary  for  a  series  of  tests  should  all  be 
prepared  at  one  time.  The  water,  acid  and  albumen 
always  mixed  before  adding  the  pepsin.  Pepsin  acts  upon 
albumen  at  from  60°  F.  to  140°  F.,  and  the  rapidity  of 
digestion  keeps  pace  with  the  temperature  up  to  130°  F. 
At  blood  heat  the  results  give  more  significance  as  to  the 
effect  of  the  ferment  in  the  body.  Five  or  six  hours,  the 
usual  time,  also  provides  ample  opportunity  for  a  full 
practical  test.  But  the  pepsin  which  gives  best  results  at 
105°,  will  give  the  best  results  at  130°  and  it  would  be 
practicable  to  make  a  test  which  at  130°  might  be  equiva- 
lent to  the  usual  test,  be  much  quicker  and  equally 
reliable. 

It  is  sometimes  proposed  to  test  pepsin  by  the  amount 
of  peptone  formed.  This,  whilst  theoretically  exact,  is  im- 
practicable and  unnecessary.  There  are  a  variety  of  soluble 
derivatives  of  albumen  not  well  understood  and  difficult  and 
tedious  of  assay  even  with  experience.  Solution  is  the  char- 
acteristic effect — the  pepsin  which  converts  the  most  albu- 
men into  solution  is  the  most  active  and  will  have  formed 
necessarily  the  most  of  all  soluble  products,  peptones,  etc. 
No  two  published  tests  at  the  present  time  call  for  exactly 
the  same  proportions  ;  the  same  product  will  give  varying 


54 

results  in  each  test.  It  is  very  important,  therefore,  that 
we  should  have  a  standard  test  and  that  the  digestive 
power  stated  for  each  and  every  pepsin,  or  preparation  of 
pepsin,  should  be  that  determined  under  the  standard 
conditions.  Whatever  the  quantity  of  albumen  used 
(according  to  the  strength  of  the  pepsin)  the  ratio,  the 
proportion  of  albumen,  water  and  acid  should  always  be 
the  same.  We  have  employed  these  proportions  :  Coagu- 
lated Egg  Albumen,  150  grains  (10  Gm.),  Water,  i  fluid 
ounce  (29.7  c.c.),  Hydrochloric  Acid,  5  minims  (0.3  c.c.) 

In  the  comparative  tests  it  is  essential  that  the  condi- 
tions shall  be  exactly  alike  in  each  test.  The  mixtures 
should  all  be  prepared  cold  in  bottles  of  the  same  size  and 
well  shaken  to  secure  uniform  conditions  before  adding 
the  pepsin.  Then  the  ferment  added  and  all  the  flasks 
placed  at  once  in  a  warm  chamber  with  constant  tem- 
perature of  105°  F.  on  an  automatic  shaker.  The  pro- 
portion of  albumen  dissolved,  the  percentage  left  at  close 
of  test  affords  fair  evidence  of  the  digestive  value  of 
each  specimen. 


EXTRACTUM  PANCREATIS. 
(FAIRCHILD.) 

This  extract  of  the  pancreas  presents  all  the  active 
principles  of  the  gland  in  the  form  of  a  dry,  whitish 
powder.  It  is  not  an  artificial  compound,  it  is  absolutely 
free  from  all  added  substances,  and  contains  the  ferments 
as  they  are  naturally  associated. 


55 

The  Extractum  Pancreatis  which  we  originated  in  i8Si 
was  the  first  product  offered  to  the  medical  profession 
containing  all  the  pancreas  principles  in  a  pure,  dry 
powder.  It  was  originally  far  more  active  and  available 
than  any  other  pancreatic  product  (the  pancreatines  were 
practically  useless),  and  since  then,  the  Extractum  Pan- 
creatis has  shown  the  result  of  the  persistent  efforts  to 
increase  its  efficiency  and  refinement.  It  is  not  too  much 
to  say  that  probably  no  remedial  agent  introduced  during 
this  decade  has  been  of  greater  importance  and  value  in 
practical  medicine.  Whilst  the  complex  digestive  action 
of  the  pancreatic  juice  was  well  known  to  physiologists, 
it  had  been  but  little  utilised  previous  to  the  introduction 
of  Fairchild's  Extractum  Pancreatis. 

By  means  of  the  Extractum  Pancreatis,  the  pancreas 
ferments  are  now  effectively  administered  and  are  steadily 
advancing  in  repute  as  therapeutic  agents.  The  Extractum 
Pancreatis  has  further  been  the  means  and  the  basis  of  all 
the  great  progress  made  in  the  peptonising  process,  which 
has  revolutionised  the  feeding  of  the  sick  and  provided  the 
long  sought  means  for  the  conversion  of  caseine  to  the 
requirements  of  the  infant's  stomach  and  to  the  standard 
of  mothers'  milk. 

As  a  solvent  for  diphtheritic  membrane  and  as  a  "  sur- 
gical solvent,"  the  Extractum  Pancreatis  has  been  so 
successfully  applied,  as  to  merit  far  more  extended  use 
and  promise  a  still  wider  increase  of  utility.  The  Extractum 
Pancreatis  is  by  far  the  best  simple  product  from  the 
gland  and  inasmuch  as  "  pancreatines "  are  often  unfit 
for  medicinal  uses  and  are  for  the  most  part  valueless, 
it  is  well  worth  while  to  avoid  disappointment  by  speci- 
fying Extractum  Pancreatis,  Fairchild. 

The  Extractum  Pancreatis  presents  all  the  digestive 


56 

ferments  of  the  pancreas  in  an  exceedingly  active  form 
— viz.: 

TR  YPSIN,  which  converts  albumens  (of  Milk,  Beef,  Fish, 
Blood,  etc.}  into  Peptone  in  either  neutral,  alkaline,  or 
slightly  acid  media. 

DIASTASE,  which  converts  starches  into  dextrine s  and 
sugar. 

THE  EMULSIVE  FERMENT,  essential  to  the  assimila- 
tion of  fats  and  oils. 

THE  MILK-CURDLING  FERMENT. 

This  EXTRACT  OF  THE  PANCREAS  contains  all 
these  digestive  principles  in  such  a  degree  of  activity  that  their 
presence  and  their  action  upon  various  food  substances  can  be 
quickly  demonstrated. 

EXTRACTUM  PANCREATIS. 

AS    A    REMEDY    PER    SE. 

' '  The  pancreatic  secretion  is  the  most  energetic  and  general  in  its 
action  of  all  the  digestive  juices.  It  unites  in  itself  the  action  of  the 
saliva  and  the  gastric  juices,  besides  having  properties  of  its  own." — 
T.  LAUDER  BRUNTON. 

In  view  of  the  very  partial  transformation  of  carbo- 
hydrates and  proteids  by  the  salivary  and  gastric  juices, 
preliminary  to  further  and  complete  digestion  by  the 
pancreas  juice,  it  would  seem  that  an  active  extract  of 
pancreas  should  possess  remedial  value  of  corresponding 
importance.  The  use  of  the  pancreas  ferments  as  aids  to 
digestion  has,  however,  been  much  prejudiced  by  theoreti- 
cal views,  and  especially  by  the  erroneous  impression  that 
they  are  only  active  in  alkaline  media.  The  questions  as 
to  whether  the  pancreatic  ferments  are  capable  of  exerting 
any  influence  upon  food  in  the  presence  of  the  gastric 
juice,  the  effects  of  the  gastric  juice  upon  them,  have 


57 

been  the  subject  of  much  experiment  and  discussion,  result- 
ing in  conflicting  theories  and  conclusions  ;  some  asserting 
that  the  pancreas  ferments  can  resist  the  gastric  juice, 
others  that  they  are  therein  rendered  permanently  inert. 
That  in  the  flask  the  pancreatic  ferments  are  destroyed  by 
free  hydrochloric  acid  plus  pepsin,  is,  we  think,  beyond 
question.  In  discussing  the  compatibility  and  value  of 
solutions  of  the  mixed  ferments  (gastric  and  pancreatic)  we 
pointed  out  the  fact  that  in  a  solution  with  pepsin  and  acid, 
the  pancreatic  ferments  gradually  become  inert,  the  practical 
lesson  being  plainly  that  the  chemist  should  not  offer,  nor  the 
physicians  accept,  remedies  of  this  class.  But  to  determine 
the  bearing  of  these  facts  upon  the  exhibition  of  the  pan- 
creatic ferments, it  is  necessary  to  consider  (as  in  the  case 
of  all  such  experiments)  the  relations  which  the  test  tube 
conditions  bear  not  only  to  those  of  normal  digestion, 
but  to  the  abnormal  conditions  which  call  for  the  ad- 
ministration of  the  ferments.  Our  present  knowledge 
of  the  phenomena  of  normal  gastric  digestion  plainly 
shows  that  there  are  opportune  intervals  for  the  presumably 
effective  introduction  of  the  pancreatic  ferments.  This  is 
admitted  even  in  the  most  conservative  estimates  of  their 
utility.  There  is  the  resource  of  specially  adapted 
pharmaceutical  products.  There  is  a  marked  difference 
in  the  nature  and  degree  of  the  acidity  of  gastric  juice 
during  stomach  digestion.  There  are  always  organic 
acids  set  free  from  the  food,  and  thus  replacing  a  por- 
tion of  the  hydrochloric  acid  ;  the  hydrochloric  acid  is 
not  free  and  uncombined,  and  the  gastric  juice  does 
not  correspond  in  its  behavior  to  a  simple  solution  of 
similar  percentage  of  free  hydrochloric  acid  in  water. 
The  presence  of  the  products  of  digestion  both  pro- 
teids  and  carbo-hydrates  may  greatly  influence  the  be- 
havior of  these  ferments  when  brought  into  contact.  In 
a  word,  in  the  phenomena  of  digestion  we  have  factors 


58 

which  materially  differ  from  those  of  laboratory  experiments 
and  must  necessarily,  therefore,  qualify  the  deductions 
therefrom.  Among  those  physicians  who  have  given 
practical  trial  to  the  Extractum  Pancreatis  in  intestinal 
indigestion,  carefully  regulating  the  mode  of  adminis- 
tration, there  exists  no  question  of  its  distinct  therapeutic 
value.  The  feebler  the  digestion  the  less  the  question 
of  interference  of  the  gastric  juice  is  to  be  considered. 
The  Extractum  Pancreatis  is  to  be  regarded  first,  as  adias- 
tasic  agent  ;  second,  as  a  digestive  of  albuminous  food  ; 
third,  as  the  only  means  of  administering  the  ferment 
which  digests  fat.  Foster's  Physiology  says,  "  there  is  no 
means  of  distinguishing  the  amylolytic  ferment  of  the 
pancreas  from  ptyalin."  Therefore,  the  Extractum  Pan- 
creatis may  be  given  as  aid  to  digestion  of  starches — 
either  at  the  outset  of,  or  at  proper  intervals  after 
gastric  digestion.  Given  at  the  interval  after  eating, 
when  the  gastric  action  has  subsided,  and  the  ingesta 
freely  passing  into  the  duodenum,  the  pancreatic  extract 
(in  the  form  of  tablets  preferably)  may  be  effectively 
administered  in  intestinal  indigestion.  In  cases  of  almost 
complete  abeyance  of  the  digestive  functions,  as  in 
fevers,  etc.,  the  stomach  affords  the  necessary  condi- 
tions for  the  action  of  the  pancreas  ferment  which  may  be 
given  mixed  with  a  suitable  food,  such  as  milk,  cold  or 
warm.  In  such  cases,  it  will  be  found  on  trial  that  no 
preliminary  digestion  (peptonisation)  is  necessary  to 
insure  the  proper  conversion  of  the  food  without  taxing 
or  disturbing  the  stomach  itself.  This  is  not  stated  on 
the  basis  of  theory,  but  as  supported  by  actual  clinical 
experience. 

The  Extractum  Pancreatis  may  be  given  in  three  to 
five  grain  doses — in  powder  mixed  with  food,  in  capsules, 
or  Fairchild  tablets,  or  in  suitable  combination.  The 
Extractum  Pancreatis  has  been,  upon  theoretical  and  practi- 


cal  grounds,  recommended  in  the  treatment  of  diabetes. 
As  a  rational  remedy  for  insufficient  salivary  digestion,  for 
intestinal  indigestion,  it  is  constantly  gaining  the  confi- 
dence of  the  profession. 

T  R Y  PS  I N . 

(FAIRCHILD.) 

ESPECIALLY  PREPARED  AS  A  SOLVENT  FOR 
DIPHTHERITIC  MEMBRANE. 

This  product  presents  the  proteolytic  ferment  of  the 
pancreas  in  the  most  active  form  obtainable. 

Trypsin  has  the  property  of  digesting  fibrin  with 
great  rapidity. 

It  is  most  effective  in  a  slightly  alkaline  solution,  but 
may  be  effectively  applied  direct  to  fibrinous  membrane, 
etc.,  either  dry  or  in  pure  water. 

It  is  an  entirely  innocent  and  non-irritant  substance, 
and  does  not  attack  the  healthy  or  non-fibrinous  tissue. 

In  its  application  to  the  throat  all   the   conditions  are 
.favorable  to  its  physiological  action. 

Trypsin  will  be  found  to  be  a  powerful  solvent  of 
diphtheritic  membrane  in  all  cases  in  which  it  is  prac- 
ticable to  bring  it  in  contact  with  the  membrane. 

Trypsin  is  especially  useful  in  cases  where  acid  media 
is  not  admissible,  and  is  to  be  chosen  also  in  all  situations 
where  the  smallest  possible  bulk  of  solvent  agent  is 
desirable. 

Trypsin  may  be  applied  by  insufflation,  pure  or  mixed 
with  sodium  bicarbonate — four  grains  Trypsin  to  one  of 
soda  ;  or  may  be  taken  up  on  a  wetted  brush  or  probang, 
or  mixed  with  water  and  sprayed  ;  Trypsin,  gr.  15,  soda 
bicarb.,  gr.  5,  water,  f  I  i,  to  be  prepared  fresh  every 
few  hours,  or  chloroform  or  pure  creosote,  4  drops,  may 
be  added  as  a  preservative.  For  further  details,  see  sur- 
gical use  of  the  digestive  ferments,  p.  83,  et  seq. 


60 

DIASTASIC  ESSENCE   OF  PANCREAS. 
(FAIRCHILD.) 

THE  MOST  ACTIVE,  RELIABLE  AND  AGREEABLE  AGENT  FOR 
THE  DIGESTION  OF  FARINACEOUS  FOODS. 

This  preparation  has  been  made  with  the  especial  pur- 
pose of  obtaining  the  diastase  or  starch-digesting  principle 
in  an  active  and  agreeable  form. 

The  need  had  been  often  expressed  to  us  by  physicians, 
of  a  purely  diastasic  preparation  by  means  of  which  they 
might  assist  the  digestion  of  starch  without  at  the  same 
time  introducing  other  digestive  agents,  or  in  any  other  way 
interfering  with  the  process  of  digestion. 

In  meeting  these  requirements,  this  Essence  has,  we  be- 
lieve, been  found  peculiarly  serviceable.  It  acts  upon 
starch  with  great  energy  and  promptness. 

Inasmuch  as  the  diastase  of  the  pancreatic  juice  acts  upon 
starch  in  a  manner  precisely  similar  to  that  of  the  saliva, 
this  Diastasic  Essence  may  be  confidently  expected  to 
compensate  for  insufficient  salivary  digestion.  For  this 
purpose  it  should  be  given  at  meal  time — either  im- 
mediately before  or  with  the  food.  When  the  intestinal 
digestion  of  starch  is  at  fault,  it  should  be  given  an  hour  or 
so  after  food. 

This  Essence  of  Pancreas  is  gratefully  aromatic  and 
acceptable  to  the  most  delicate  stomach,  and  will  be  found, 
therefore,  more  efficient  and  agreeable  as  a  diastasic  agent 
than  the  thick,  sweet  extracts  of  malt. 

It  will  sometimes  be  advantageous  to  mix  the  diastasic 
essence  directly  with  the  foods,  such  as  oatmeal,  rice,  etc., 
especially  for  children  who,  owing  to  defective  dentition  or 
ill  health,  evince  difficulty  in  the  digestion  and  assimilation 
of  starchy  foods  at  an  age  when  it  is  desirable  that  milk 
should  no  longer  be  the  sole  article  of  diet. 

The  Essence  should  never  be  added  to  food  when  too 
hot  to  be  borne  agreeably  by  the  mouth. 

Usual  dose,  one  or  two  teaspoon/ it  Is. 


PEPTONISING    TUBES 

(FAIRCHILD.) 

FOR  THE  PREPARATION  OF  PEPTONISED  MILK   AND  OTHER 
'   PREDIGESTED  FOOD  FOR  THE  SICK. 


•  (EXACT  SIZE.) 

Use  the  contents  of  each  tube  for  peptonising  one  pint 
of  milk. 

These  tubes  of  "  peptonising  powder "  are  the  most 
convenient  means  for  prescribing  and  using  the  Extractum 
Pancreatis  for  the  purpose  of  peptonising  milk. 

By  this  means  the  peptonising  powder  is  supplied  in  an 
•accurate  and  portable  form,  secured  from  deterioration, 
and  dispensed  at  a  moderate  fixed  price. 

Each  package  contains  complete  directions  for  prepar- 
ing peptonised  milk,  beef,  gruel  and  a  great  variety  of 
foods  for  the  sick  by  means  of  the  Fairchild  Practical 
Recipes. 

The  tubes  can  be  sent  by  mail.  Retail  price,  50  cents 
per  box  of  one  dozen  tubes. 

FAIRCHILD'S     "DIRECTION     SLIPS" 


PEPTONISED     MILK,     BEEF,     GRUELS,     ETC. 

For  the  convenience  of  the  physician  we  devised  these 
"direction  slips"  in  small  pads  of  proper  size  for  the  vest 
pocket.  The  pad  contains  a  number  of  slips  of  direc- 
tions for  each  sort  of  food — peptonised  milk  by  the  cold 
process,  and  for  jellies,  for  punches,  etc.;  peptonised 
gruel,  peptonised  beef,  junket,  whey,  etc. 

By  this  means  the  physician  is  enabled  to  leave  with 
the  patient  or  nurse  plain  printed  directions  for  the 
special  food  and  method  he  may  desire  to  order.  These 
direction  slips  have  proven  very  acceptable  to  the  profes- 
sion. We  shall  be  pleased  to  send  them  by  mail  upon 
request. 


62 
PEPTOGENIC   MILK   POWDER 

VIELDS    A    FOOD     FOR     INFANTS    WHICH     IN     PHYSIOLOGICAL, 

CHEMICAL     AND     PHYSICAL     PROPERTIES     IS     ALMOST 

IDENTICAL  WITH   HUMAN   MILK,  AND    AFFORDS 

A     COMPLETE     SUBSTITUTE      THEREFOR 

DURING     THE    ENTIRE     NURSING 

PERIOD. 

.  By  means  of  the  Peptogenic  Milk  Powder  and  process, 
cows'  milk  is  so  modified  and  pre-digested  as  to  con- 
form remarkably  in  every  particular  to  normal  human 
milk,  thus  affording  a  "  humanised  milk,"  exactly  suited 
to  the  functions  of  infant  digestion,  calling  forth  the 
natural  digestive  powers  of  the  stomach  and  supplying 
every  element  of  nutritfmi  competent  for  the  nourish- 
ment and  development  of  the  healthy  nursing  infant. 

It  is  also  a  peculiar  feature  of  this  method  that  the 
milk  may  be  given  just  that  degree  of  digestibility  suitable 
to  especial  requirements, — in  cases  of  naturally  feeble 
digestion  and  during  the  disorders  of  infancy. 

The  Peptogenic  Milk  Powder  is  put  up  in  $1.00  and  in 
50  cent  packages,  and  sold  by  the  principal  drug  houses  in  the 
United  States  and  Canada.  Sample  can  of  the  Peptogenic 
Powder  and  pamphlet  will  be  sent  gratis  upon  request. 
Correspondence  solicited. 

TESTS  FOR  PANCREATIC  PREPARATIONS. 

The  pancreatic  juice  and  the  gland  itself  are  well 
known  to  be  extremely  subject  to  decomposition,  hence 
the  greatest  care  and  skill  are  required  in  manufacturing 
available  medicinal  products  from  this  source.  The 
value  of  a  pancreatic  preparation  must  depend  not  only 
upon  its  digestive  activity,  but  upon  the  character,  the 
quality  of  the  digested  product  it  yields.  A  pancreatic 
extract  may  convert  the  caseine  of  milk  into  peptone,  yet 


63 

the  peptonised  milk  be  quite  unfit  for  food,  owing  to  the 
development  of  rancid  fatty  acids,  giving  the  milk  a  pecul- 
iar repulsive  odor  characteristic  of  regurgitated  milk  from 
a  sour  stomach.  A  pancreatic  preparation  which  produces 
such  a  result  with  milk,  is  plainly  unfit  for  any  medicinal  use. 

We  have  in  the  past  not  infrequently  had  occasion  to 
examine  such  commercial  "  pancreatines."  A  good  pan- 
creatic extract  should  rapidly  digest  milk,  beef,  fibrin  and 
all  forms  of  starchy  food, — should  convert  the  caseine  of 
warm  milk  into  peptone  without  the  development  of  any 
rancid  flavor  whatever.  The  action  upon  caseine  may  be 
taken  as  a  sufficient  test  of  the  proteolytic  power  upon 
any  proteid.  The  activity  and  quality  of  a  pancreatic 
preparation  may  be  readily  tested  in  the  following  manner  : 

Put  into  a  flask  15  grains  of  sodium  bicarbonate  and 
4  fluid  ounces  of  cold  water,  add  5  grains  of  Extractum 
Pancreatis,  mix  well  and  add  one  pint  of  milk  warmed 
to  130°  F.  Shake  well  and  place  the  bottle  convenient 
for  observation.  At  first  there  should  be  no  foreign 
odor  or  taste  imparted  to  the  milk.  In  a  few  moments 
the  milk  will  become  of  slightly  grayish  yellow  color, 
which  in  ten  minutes  will  be  more  marked  and  the  milk 
thinner  and  of  a  distinct  bitter  taste,  due  to  the  conver- 
sion of  the  caseine.  This  taste,  even  when  peptonisation 
is  complete,  is  a  pure  bitter  without  any  suggestion  of 
fermentation  or  rancidity.  By  having  another  flask  of 
the  milk  mixed  with  the  soda  and  water  without  ferment, 
the  progress  of  the  digestion  may  be,  by  comparison,  more 
readily  observed.  These  physical  changes  of  milk,  during 
peptonisation,  are  so  characteristic,  that  anyone  familiar 
with  the  process,  may  very  readily  regulate  the  process 
accordingly.  By  withdrawing  a  small  portion  of  the 
milk  from  time  to  time  and  adding  a  few  drops  of 
acetic  acid,  the  conversion  of  the  caseine  may  be  tested, 


64 

by  the  character  of  the  curd  formed — from  the  familiar 
tough  caseine,  to  the  light,  flocculent  precipitate,  and  the 
final  slight,  scarcely  perceptible,  granular  coaguli. 

To  test  the  diastasic  property  of  a  pancreatic  prepar- 
ation, prepare  thick,  gelatinous  starch,  by  mixing  a  drachm 
of  arrowroot  or  starch  with  five  fluid  ounces  of  cold  water, 
and  boiling  well.  To  a  fluid  ounce  of  this  mucilage  (at 
110°  F.),  add  a  grain  or  so  of  the  pancreatic  extract  or  a 
few  drops  of  a  fluid  product  and  stir  well.  The  starch 
should  become  almost  instantly  thin  and  fluid,  like  water, 
showing  the  forn  ~tion  of  soluble  starch,  which  is  grad- 
ually converted  into  dextrine  and  glucose.  A  product 
which  does  not  quickly  liquefy  thick,  warm  starch  jelly 
is  worthless  as  a  diastasic  agent. 

THE  FAIRCHILD  DIGESTIVE  TABLETS. 

A    PORTABLE    AND    EXACT    FORM    OF    DOSAGE    OF    THE 
DIGESTIVE    FERMENTS. 

These  tablets  are  unique  in  form,  agreeable  to  the 
taste  and  easily  carried  about  in  the  pocket.  They  are 
offered  as  a  means  of  exhibiting  the  digestive  ferments  in 
divided  doses  and  at  the  particular  interval  after  the  in- 
gestion  of  the  food,  which  gives  the  most  favorable  con- 
dition for  their  action.  The  advantages  of  this  method 
of  administration  are  apparent,  especially  in  duodenal 
dyspepsia.  The  tablets  should  preferably  be  swallowed 
whole. 

The  various  combinations  are  supplied  in  small  vials 
and  it  is  recommended  that  they  be  prescribed  in  original 
bottles.  The  directions  of  the  physician  will  be  affixed 
by  the  druggist  in  place  of  our  label,  if  so  desired  ;  but 
it  will  be  economical  to  the  patient  to  order  the  original 
vial.  They  are  also  supplied  in  large  vials  in  any  quan- 
tity desired. 


65 

PEPSIN    TABLETS. 
(FAIRCHILD.) 

Each  tablet  contains  one  grain  of  our  pure  Pepsin  in 
Scales,  combined  with  acids  and  appropriate  aromatics. 
Dose — one  or  two  tablets  immediately  after  eating  and 
repeated  when  required. 

These  tablets  afford  a  means  of  re-enforcing  the  gas- 
tric digestion  at  frequent  intervals  after  the  ingestion  of 
food.  The  advantages  of  this  method  of  administering 
the  peptic  ferment  have  been  well  advanced  in  an  editorial 
in  the  New  Remedies,  from  which  we  quote;  and  the  need 
of  an  available  preparation  for  the  purpose  having  been 
urged  upon  our  attention,  we  originated  these  Pepsin 
Tablets  which  have  proven  very  useful  and  greatly 
appreciated. 

"  Still  another  fact  exists,  although  it  has  apparently  been  lost  sight 
of  in  practice,  and  is  rarely  or  never  mentioned  by  writers  on  disorders 
of  digestion,  viz.:  that  much  better  results  will  follow  the  administra- 
tion of  the  pepsin  in  divided  doses  during  the  process  of  digestion,  and 
at  intervals  of  a  few  minutes,  than  when  it  is  given  in  one  dose.  The 
reason  for  this  is  the  fact  that  as  peptones  are  formed  in  the  stomach, 
they  are  absorbed  or  passed  through  the  pylorus  into  the  intestine,  and 
carry  with  them  a  certain  proportion  of  the  ferment  which  produces'  this 
change,  and  that  in  a  case  where  the  gastric  juice  is  of  notably  poor 
quality,  and  artificial  pepsin  is  employed,  the  digestive  action,  which 
at  first  may  be  quite  efficient,  grows  weaker  and  weaker,  and  fresh  sup- 
plies of  pepsin  are  required  from  time  to  time  to  maintain  the  pro- 
cess. *  *  *  " — JVetv  Remedies. 

PEPSIN  AND  BISMUTH  TABLETS. 
(FAIRCHILD.) 

Each  tablet  contains  one  grain  of  pure  Pepsin  (Fair- 
child)  and  two  grains  of  Bismuth  Subnitrate. 

Pepsin  and  Bismuth  constitute  one  of  the  most  efficient 
and  generally  used  combinations  in  the  treatment  of 


66 

dyspepsia.     In  these  tablets  these  remedies  are  presented 
in  an  exact,  agreeable  and  efficient  form. 

The  well-known  chemical  incompatibilities  between 
Pepsin  and  Bismuth,  in  solution,  and  the  criticisms  justly 
urged  against  such  a  combination,  have  led  some  to  the 
impression  that  this  objection  is  true  of  Pepsin  and  Bis- 
muth mixtures  generally. 

There  is  no  question  of  incompatibility  between  Pepsin 
and  Bismuth,  except  as  relates  to  the  Ammonia  Citrate  in 
solutions,  a  salt  of  Bismuth,  moreover,  which  is  greatly 
inferior  to  the  Subnitrate.  The  Bismuth  Subnitrate  is  well 
known  to  be  very  beneficial  in  certain  forms  of  dyspepsia, 
and  its  properties  are  in  no  way  inimical  to  the  action  of 
the  gastric  juice  or  to  that  of  artificial  peptic  agents 
administered  in  conjunction  with  it. 

USUAL  DOSE. — One  or  two  tablets  immediately  before  or 
after  each  meal,  or  at  any  time  when  suffering  from  indigestion. 

PEPSIN,  BISMUTH  AND  PANCREATIC  TABLETS. 
(FAIRCHILD.) 

Each  tablet  contains — Pepsin  (Fairchild),  i^  grains, 
Ext.  Pancreatis  (Fairchild),  \\  grains,  Bismuth  Subnitrate, 
2  grains. 

USUAL  DOSE. — One  or  two  of  these  tablets  should  be  taken 
either  shortly  before  or  after  meals,  as  may  prove  best  suited  to 
the  particular  case. 

"PEPSIN    AND    PANCREATINE"    TABLETS. 
(FAIRCHILD.) 

Each  tablet  contains — Pepsin  (Fairchild),  2  grains, 
Extractum  Pancreatis  (Fairchild),  3  grains, 


This  formula  has  been  prescribed  for  some  years  by 
physicians  of  this  city  under  the  name  of  "  Pepsin  and 
Pancreatine,"  and  we  have  supplied  them  uncoated  for 
dispensing.  The  increasing  demand  made  it  necessary 
for  us  to  prepare  them  in  a  manner  uniform  with  our  other 
digestive  tablets,  in  order  to  permanently  protect  them 
from  change. 

The  coating  is  perfectly  soluble,  and  does  not  interfere 
with  their  digestive  action. 

One  tablet,  three  times  a  day,  is  generally  prescribed  as  a 
dose. 

PEPSIN     AND    DIASTASE 

(FAIRCHILD.) 
IN  TABLETS,  EACH  CONTAINING  TWO  GRAINS. 

This  combination,  which  is  original  with  us,  is  the  only 
preparation  in  which  the  pure  diastasic  and  peptic  ferments 
have,  we  believe,  been  united  in  an  active  form.  The 
value  and  appropriateness  of  this  combination  is  apparent. 

It  is  certainly  in  clearest  accordance  with  physiological 
principles.  It  is  a  well-ascertained  fact  that  diastase, 
whether  obtained  from  saliva,  the  pancreatic  juice,  or  from 
germinated  grain,  acts  upon  starch  in  an  identical  manner 
and  under  identical  conditions.  "  Pepsin  and  diastase  " 
may,  therefore,  be  given  with  every  anticipation  of  benefi- 
cial results  in  cases  of  dyspepsia,  where  both  the  salivary 
and  gastric  digestion  are  at  fault. 

This  combination  is  prepared  with  our  pure  pepsin,  with- 
out admixture  of  malt  sugar,  starch  or  other  substance,  and 
in  such  a  manner  that  an  ordinary  dose  contains  an 
efficient  proportion  of  the  diastasic  ferment. 

This  product  is  not  to  be  classed  among  those  sacchar- 
ated  "  digestive  compounds  "  which  purport  to  contain  "all 


the  agents  of  digestion  " — diastase  included.  It  is  sufficient 
here  to  say  that  not  one  of  them  contains  an  appreciable 
quantity  of  diastase  from  any  source.  If  a  preparation 
contains  active  diastase,  it  must  liquefy  gelatinous  starch 
at  the  temperature  of  the  body. 

One  or  more  tablets  for  a  dose  at  meal  time,  or  when  suffer- 
ing from  indigestion. 

PEPSIN,    BISMUTH   AND    NUX   VOMICA 
TABLETS. 

(FAIRCHILD.) 

Each  tablet  contains  Fairchild's  Pepsin,  3  grains,  Bis- 
muth Subnitrate,  2  grains,  Extract  Nux  Vomica,  £  grain. 

COMPOUND    OX    GALL   TABLETS. 
(FAIRCHILD.) 

Each  tablet  contains — Inspissated  Ox  Gall  (Fairchild), 
2  grains,  Extractum  Pancreatis  (Fairchjld),  2  grains,  Ex- 
tract Nux  Vomica,  \  grain. 

These  two  combinations  having  been  much  prescribed, 
we  have  manufactured  them  in  our  tablet  form  by  request. 

PANCREATIC    TABLETS. 
(FAIRCHILD.) 

Each  tablet  contains  3  grains  Fairchild's  Extractum 
Pancreatis. 

COMPOUND    PANCREATIC    TABLETS. 
(FAIRCHILD.) 

This  tablet,  originally  designed  for  the  treatment  of 
intestinal  indigestion,  has  proven  of  great  service  and  has 


69 

been  for  some  years  extensively  prescribed.  The  pure 
Extractum  Pancreatis  is  here  combined  with  bismuth  sub- 
nitrate,  highly  esteemed  in  allaying  irritability  of  the  ali- 
mentary tract,  and  with  ipecac,  which,  in  small  doses,  is 
the  most  admirable  stimulant  of  the  intestinal  digestion. 

Each  tablet  contains — Extractum  Pancreatis  (Fair- 
child),  2  grains,  Bismuth  Subnitrate,  3  grains,  Powdered 
Ipecac,  -j^  grain. 

One  or  two  tablets  for  a  dose,  an  hour  or  two  after  eating. 

PEPTONATE    OF    IRON 

(FAIRCHILD), 
IN  TABLETS,  EACH  CONTAINING  THREE  GRAINS. 

Dose  for  an  adult,  usually  one  tablet  thrice  a  day  after 
meals. 

FERROGLOBIN    TABLETS. 

Ferroglobin  contains  the  element  iron,  united  with 
the  proteid  matter,  as  a  constituent  of  the  molecule  itself, 
thus  presenting  this  important  principle  in  a  form  pecul.iar 
to  the  blood  and  impossible  to  produce  artificially.  Ferro- 
globin, therefore,  may  be  considered  to  offer  many  advan- 
tages over  any  chemical  compound  of  iron  or  any  of  the 
mixtures  of  iron  and  albumen.  Ferroglobin,  in  distinction 
from  all  such  artificial  compounds,  presents  the  organic, 
physiological  ferruginous  element  of  the  blood.  It  is 
recommended  in  all  anaemic  conditions  where  it  is  desired 
to  administer  iron  in  a  perfectly  soluble  and  assimilable 
form.  It  is  prepared  with  the  utmost  care  and  offered  in 
tablet  form  as  the  most  permanent  and  acceptable  prepa- 
ration for  medical  use. 

Each  tablet  contains  2  grains  of  pure  Ferroglobin. 

THE    PEPTONISING    PROCESS. 

To  peptonise  food  is  to  artificially  digest  food,  to  submit 
it  to  the  action  of  the  digestive  ferments,  by  which  means 


70 

changes  are  effected  precisely  similar  to  those  which  in  the 
living  body  are  the  essential  preliminary  to  its  absorption. 
For  the  two  great  types  of  food  stuff,  flesh  and  starch  foods 
are  incapable  of  being  absorbed  until  they  have  become 
soluble  by  the  action  of  the  digestive  juices,  and  thus 
capable  of  passing  through  the  walls  of  the  alimentary 
canal.  This  characteristic  action  of  the  digestive  ferments, 
the  conversion  of  insoluble  and  unabsorbable  substances 
into  soluble  and  assimilable,  is  seen  in  the  artificial 
digestion  of  food. 

The  fibre  of  beef  is  seen  to  gradually  soften  and  dis- 
solve ;  thick,  well-boiled,  gelatinous  starch  (gruel)  is 
seen  to  quickly  dissolve,  become  thinner  and  watery.  Fari- 
naceous foods  as  ordinarily  prepared,  such  as  oatmeal, 
wheaten  grits,  rice,  dipped  toast,  more  slowly  soften  and 
dissolve.  Albuminous  substances,  such  as  the  caseine  of 
milk,  etc.,  acquire  when  completely  digested,  a  bitter  taste 
from  the  peptone  ;  the  farinaceous  foods  become  sweeter 
from  the  maltose  or  starch  sugar. 

Cooked  food  is  in  general  more  susceptible  to  digestion 
than  raw  food,  both  in  the  body  and  in  the  flask.  To  pep- 
tonise  food  is  then  but  to  go  a  step  beyond  what  has 
always  been  sought,  in  the  special  care  and  devices  given  to 
the  cooking  of  food  for  the  sick. 

Each  ferment  has  its  special  correlated  food  substance 
and  this  it  will  digest  in  a  flask,  just  as  in  the  alimentary 
canal.  In  discussing  the  ferments  in  detail,  we  have  already 
had  occasion  to  point  out  that  pepsin  is  not  available  for 
household  use  in  artificially  digesting  food  of  any  kind. 
Peptonised  food  is,  therefore,  not  food  prepared  with  pep- 
sin, or  indeed  necessarily  containing  a  ferment  of  any 
kind,  it  is  digested  food  ;  the  agent  of  digestion  may  or 
may  not  be  retained  in  an  active  form  after  its  work  has 
been  utilised. 


71 

The  pancreatic  ferments  are  capable  of  digesting  every 
known  form  of  food  ;  and  as  made  available  in  the  Fairchild 
Extractum  Pancreatis,  Peptonising  Tubes  and  other  special 
forms,  may  be  applied  with  marvelous  facility  for  pepton- 
ising  food  for  the  sick  by  the  Fairchild  process,  with  the 
ordinary  conveniences  of  the  sick  room. 

The  peptonising  action  is  most  energetic  at  about  the 
heat  of  the  body,  slow  at  the  temperature  of  a  room  (60  to 
70  degrees  F.)  ;  at  a  lower  temperature,  even  at  freezing, 
the  peptonising  agent  is  not  destroyed,  but  is  simply  in- 
active. At  the  boiling  heat  it  is  at  once  killed. 

Therefore  we  may  peptonise  milk  by  the  cold  process, 
in  which  the  major  work  of  the  peptonising  agent  is  done 
after  the  milk  is  taken  into  the  stomach  ;  or  by  the  warm 
process  in  which  the  milk  is  partially  digested  and  then 
cooled  to  check  digestion  ;  or  after  peptonising  to  a  cer- 
tain point  the  ferment  is  to  be  destroyed  by  boiling. 

This  boiled  or  scalded  peptonised  food  contains  now 
no  active  ferment,  no  artificial  help  to  digestion  ;  we  have 
removed  the  food  from  further  influence  of  the  peptonising 
agent,  just  as  we  remove  food  from  the  fire  after  cooking. 

It  will  be  seen,  therefore,  in  the  Fairchild's  practical 
recipes  that  we  have  various  simple  methods,  according  to 
the  degree  of  peptonising  required,  to  suit  the  conditions 
of  a  case. 

The  effects  of  the  peptonising  process  are  as  plain  to 
sight  and  to  taste,  as  are  the  effects  of  cooking  and  afford 
as  simple  evidence  by  which  it  may  be  regulated.  It  is  in 
truth  easier  to  tell  when  a  pint  of  milk  is  peptonised  to 
suit  a  given  case,  than  it  is  to  tell  when  an  egg  is  boiled 
"soft,"  or  "well  done"  or  when  a  steak  is  properly 
broiled, 


72 

The  peptonising  powder  always  acts  uniformly  under 
given  conditions  ;  those  conditions  are  exceedingly  simple 
and  attainable. 

It  is  of  the  greatest  importance  at  the  beginning,  to 
follow  the  directions  to  the  letter.  With  familiarity  with 
the  process,  with  its  effects,  with  a  clear  idea  as  to  the 
conditions  essential  and  the  object  to  be  accomplished, 
then  one  may  take  one's  "  own  way  "  to  reach  the  desired 
result,  to  please,  or  agree  with,  any  patient. 

For  instance,  if  peptonised  milk  should  be  required  in 
an  emergency,  the  powder  may  be  mixed  in  a  saucepan 
with  warm  water  and  warm  milk  and  kept  warm  over  a 
fire,  say  for  five  minutes,  stirring  briskly,  and  sipping  fre- 
quently so  as  to  take  care  that  the  milk  is  not  overheated 
and  the  ferment  thus  destroyed.  Thus  in  a  few  minutes 
peptonised  milk  may  be  so  prepared  as  to  be  of  the 
utmost  service  in  affording  urgently  required  absorbable 
nourishment.  It  may  be  given  hot,  or  if  required  cold,  ice 
it.  Sometimes  it  will  be  found  that  the  milk  will  agree 
(when  made  by  the  warm  process),  if  it  is  put  on  ice  the 
moment  the  milk  becomes  warm  in  the  bottle,  because  the 
milk  thus  becomes  sufficiently  peptonised  before  it  becomes 
chilled. 

There  is  an  exaggerated  notion  of  the  "  trouble  "  of  the 
peptonising  process,  probably  because  of  the  novelty  of 
this  application  of  physiological  principles.  But  it  is  in 
reality  an  exceedingly  simple  process.  It  would  be  difficult 
to  instance  any  of  the  commonest  cooking  operations  so 
simple  as  mixing  a  powder,  water  and  milk  together  and 
keeping  it  in  a  warm  place  (water  bath  or  other)  for  a 
few  minutes.  If  soluble,  easily  digestible,  absorbable  food 
is,  as  by  all  conceded,  the  chief  desideratum,  how  shall  we 
so  simply,  surely  and  safely  obtain  it  as  by  the  peptonising 


ts 

process  ?  It  is  certainly  far  easier  to  peptonise  food  than  to 
prepare  most  of  the  jellies,  beef  teas  and  delicacies  in  old 
time  vogue  for  the  sick.  The  peptonised  foods  have  saved 
more  lives  in  the  ten  years  in  which  the  Fairchild  process 
has  been  in  use,  than  all  the  other  kinds  of  special  foods  for 
the  sick  that  are  made.  It  is  scientific,  practical,  successful. 
If  it  chances  that  at  the  first  attempt  or  occasionally,  the 
milk  becomes  "  too  bitter,"  surely  this  is  no  more  reason 
for  condemning  the  process  or  rejecting  it,  than  it  would 
be  to  reject  cooking  because  of  the  even  greater  difficulty 
of  boiling  an  egg  "twice  alike"  or  of  roasting  meat  "to 
a  turn." 

THE   USE   OF   SODA   IN   THE    PEPTONISING 
PROCESS. 

As  we  have  already  explained,  the  use  of  an  alkali  is 
not  essential    to  the    action   of   the  pancreatic   ferments. 

In  the  digestion  of  milk  by  the  peptonising  ferment  the 
caseine  undergoes  gradual  conversion,  and  at  a  certain 
point  acquires  the  peculiar  property  of  coagulating  at  the 
boiling  temperature. 

The  caseine  at  this  stage  of  its  conversion  is  in  the  con- 
dition most  generally  suitable  for  digestion  in  the  stomach  ; 
it  is  no  longer  caseine  and  does  not  act  like  caseine  and  yet 
not  completely  peptone  ;  for  peptone  does  not  coagulate 
when  boiled.  It  is  in  fact  a  peculiar  partially  transformed 
albuminoid  which  has  been  called  meta-caseine,  and  it 
has  been  found  that  this  may  be  prevented  from  coagu- 
lating from  boiled  milk  by  simply  rendering  it  alkaline. 
Consequently  by  the  use  of  a  small  quantity  of  soda 
bi-carbonate  we  are  enabled  to  boil  the  milk,  and  thus 
check  digestion  at  any  requisite  stage  without  coagu- 
lating the  altered  caseine.  It  is  seldom  necessary  to 


T4 

boil  peptonised  milk  for  adults  except  under  circum- 
stances when  ice  is  not  available  to  check  the  pepton- 
ising  action.  This  addition  of  soda  is  also  wholesome,  it 
neutralises  the  almost  invariable  acidity  of  cow's  milk  and 
keeps  it  sweet. 


THE    REASON    FOR    DILUTING    MILK    IN    THE 
PEPTONISING    PROCESS. 

In  the  Fairchild  process  for  peptonising  milk  we  direct 
that  the  peptonising  powder  shall  first  be  mixed  with 
water  and  then  added  to  the  milk  ;  the  object  being  to  so 
dilute  the  milk  that  it  will  not  be  curdled  by  the  digestive 
agent.  The  action  of  the  pancreas  curdling  ferment, 
which  we  have  described  on  page  37,  is  a  hindrance  to  the 
artificial  digestive  process ;  for  milk  will  peptonise  more 
readily,  be  more  convenient  for  use,  if  kept  fluid  by  the 
simple  expedient  of  diluting  it  with  a  small  proportion  of 
water. 

The  addition  of  water  in  this  proportion  is  not  in  the 
least  objectionable.  For  the  great  majority  of  cases  in 
which  peptonised  milk  is  resorted  to  as  a  diet,  the  addi- 
tional water  is  a  distinct  advantage,  for  here  it  is  that  a 
fluid  food  is  of  the  utmost  importance.  It  means  that  the 
patient  takes  with  every  pint  of  milk  four  ounces  of  water, 
and  water  is,  in  fevers,  etc.,  the  very  thing  required.  It  is  not 
so  much  concentrated  food,  as  assimilable  comprehensive 
nourishment  that  is  essential.  In  the  special  process  for 
peptonising  milk  for  infants,  we  direct  the  definite  dilu- 
tion necessary  to  yield  a  food  containing  the  proportion 
of  water  found  in  human  milk. 


75 
USES  OF  PEPTONISED  FOODS. 

It  is  no  longer  necessary  to  adduce  "  clinical  experience  " 
in  support  of  the  value  of  peptonised  foods.  Since  we  first 
had  the  honor  to  call  the  attention  of  the  medical  profession 
to  the  "  Use  of  the  Extractum  Pancreatis  in  the  Preparation 
of  Peptonised  Foods  for  the  Sick," 'these  foods  have  quite 
fulfilled  their  great  promise  of  usefulness. 

In  a  word,  when  the  physician  finds  nutrition  to  be  a 
factor  in  the  treatment  of  a  case,  this  is  where  peptonised 
foods  are  his  chief  resource.  In  peptonised  milk,  beef, 
gruels,  etc.,  by  the  Fairchild  process,  the  physician  finds 
the  food  for  the  sick  at  once  the  most  useful,  economical, 
and  congenial  to  direct  for  his  patient.  For  the  foods  pep- 
tonised are  the  foods  with  whose  composition  and  special 
nutritive  properties  and  value,  he  and  all  mankind  are 
familiar. 

If  the  digestive  functions  are  impaired,  or  even  com- 
pletely in  abeyance,  what  other  method  of  supplementing 
them  so  certain  and  so  innocent  ?  It  is  the  most  rational 
conceivable  resource  to  thus  accomplish  digestion  by  proxy 
— to  the  degree  only  necessary  to  render  the  food  assimilable. 
With  returning  health,  the  patient  neither  desires  nor  re- 
quires peptonised  foods.  The  use  of  peptonised  food 
reduces  to  a  minimum  the  inroads  which  acute  and  wasting 
diseases  make  upon  the  system.  The  physician  rationally 
anticipates  a  better  convalescence,  a  quicker  renewal  of 
normal  digestive  power,  for  that  patient  whose  nutrition  has 
suffered  the  least  degree  of  impairment.  Let  anyone  com- 
pare the  average  results  of  the  treatment,  for  instance,  of 
"  Typhoid  "  with  the  use  of  peptonised  milk,  with  the  results 
under  the  use  of  any  other  food. 


76 

There  is  the  record  of  ten  years,  of  innumerable  cases 
in  the  use  of  veritable  peptonised  foods  by  the  Fairchild 
process,  without  the  citation  of  a  single  case  of  unfavorable 
sequelae  attributable  to  the  use  of  these  foods. 

In  experiments  also  with  animals  fed  upon  peptonised 
foods,  there  is  no  evidence  of  inability  to  return  readily  to 
the  digestion  of  ordinary  food.  There  was  on  one  side  a 
mere  unsupported  conjecture  as  to  what  might  be  the  effect 
of  protracted  feeding  of  peptonised  foods  ;  on  the  other, 
we  know  its  beneficial  effect  after  ten  years  of  experience 
as  a  therapeutic  resource  ;  we  know  that  we  do  with  un- 
qualified benefit  to  the  sick,  subject  food  to  preliminary 
digestion,  and  thus  set  disease  at  defiance  in  so  far  as  it 
affects  the  most  vital  functions  of  digestion  and  nutri- 
tion. 

That  peptonised  milk  is  competent  for  the  complete 
nourishment  of  adults  in  active  life  suffering  from  gastric 
ulcer,  or  subject  to  chronic  diarrhoea,  is  abundantly  proven, 
and  many  instances  have  occurred  in  the  past  ten  years 
where  patients  have  found  this  their  only  resource  for 
nutrition.  We  especially  call  attention  to  these  typical 
cases,  the  personal  experience  of  practising  physicians  who 
have  been  enabled  to  pursue  their  profession  and  maintain 
vigorous  life  by  subsisting  solely  on  peptonised  milk  for 
years,  under  circumstances  where  otherwise  "  life  had  been 
a  burden  "  from  suffering. 

"  The  history  of  this  case  of  Acute  Dysentery  which  had 
"  progressed  from  acute  suffering  to  exhaustion,  emaciation 
"  and  hopelessness  ;  which  was  not  permanently  benefited, 
"  but  only  controlled  by  the  numerous  drugs  used  against 
"  it,  and  which  was  at  last  cured  by  a  simple  diet  of  pre- 
"  digested  milk  rigidly  adhered  to  by  the  help  of  obstinate 
"will-power,  has  appeared  to  me  unique  and  therefore  of 


"  use  to  the  profession  at  large.  It  demonstrates  that  by 
"  recourse  to  the  artificial  process  of  digestion,  we  may 
"  present  proper  nutriment  to  our  patients  under  conditions 
"  so  unfavorable  even  as  to  render  futile  all  other  thera- 
"  peutic  measures,  climatic  and  medicinal.  It  proves 
"  further,  as  will  be  shown,  that  tinder  a  prolonged  exclu- 
"sive  diet  of  so  fluid  an  aliment  as  milk  diluted  with  water 
"  and  with  its  caseine  converted  into  soluble  peptones, 
"  health  and  activity  may  be  maintained." 

"  Upon  this  diet,  of  milk  peptonised  by  Fairchild's 
"  method,  the  patient  has  now  been  living  exclusively  for 
"  more  than  two  years.  His  general  condition  is  excellent. 
"  The  functions  of  the  bowels  are  performed  with  ease 
"  and  regularity,  his  muscular  system  has  regained  its 
"  former  degree  of  average  development,  and  he  bears,  with 
"  the  same  ease,  as  do  his  fellows,  the  fatigues  of  either 
"  business  or  pleasure." 

"  As  a  physician  of  seventeen  years  of  active  practice, 
"  I  have  fully  convinced  myself  of  the  great  value  of  your 
"  '  Pure  Digestive  Ferments  ' — particularly  your  '  Ex- 
"  tractum  Pancreatis.'  But  my  most  valuable  experience 
"  has  resulted  from  my  own  personal  experience.  For 
"  three  years  I  have  suffered  with  gastric  ulcer  and 
"  Chronic  Gastritis  with  frequent  acute  attacks.  Life  was 
"  intolerable  and  seemed  about  to  terminate  when  I  began 
"  washing  out  my  stomach  with  medicated  water  and 
"resorted  to  a  diet  of  'peptonised  milk.'  For  37  months  I 
"  have  lived  absolutely  upon  peptonised  milk,  porridge  and 
"  gruel." 

In  acute  and  wasting  diseases,  Typhoid,  Pneumonia, 
Gastric  Ulcer,  Diabetes,  Tuberculosis,  Chronic  Diarrhosa, 


78 

Pyloric  and  Intestinal  Obstruction,  Gastric  Catarrh,  etc., 
as  a  food  both  preparatory  and  subsequent  to  important 
surgical  operations,  peptonised  milk,  gruel,  etc.,  are  the 
classical  resource.  In  times  of  great  fatigue  and  nervous 
prostration,  when  the  strength  is  exhausted  by  severe  strain 
of  work  and  anxiety,  when,  as  it  is  expressed,  one  is  "  too 
tired  to  eat,"  then  peptonised  milk  has  the  most  remarkable 
restorative  power.  See  "Hot Peptonised  Milk."  {Practical 
Recipes. ) 

In  Typhoid  Fever,  peptonised  milk  promises,  and 
proves  the  "ideal  food";  it  precludes  all  accumulation 
of  unassimilable  matter  in  the  digestive  tract  and  meets 
every  requirement.  It  affords  also  the  best  vehicle  and 
the  most  agreeable  for  the  exhibition  of  the  spirits,  whisky, 
brandy,  etc. 

We  do  not  recommend  peptonised  milk  for  feeding 
nursing  infants,  nor  the  use  of  the  Peptonising  Ttibcs,  for 
preparing  peptonised  milk  for  infants.  In  "  petonised 
milk  "  (with  the  tubes),  there  is  no  attempt  to  adjust  the 
milk  quantitatively  to  a  correspondence  with  human  milk, 
nor  to  attain  the  definite  proper  conversion  of  the  caseine. 
There  is  no  reason,  therefore,  for  using  for  an  infant  this 
method  of  peptonising  milk  designed  for  adults,  when  in 
the  Peptogenic  Milk  Pou'der  the  process  is,  in  every  detail, 
adjusted  to  the  analysis  of  normal  human  milk. 

Humanised  Milk  as  prepared  with  the  Peptogenic  Milk 
Powder  is  frequently  preferred  by  the  physician  as  a  food 
for  adults — in  phthisis,  Bright's  disease,  etc.,  because  it  is  so 
fluid  and  agreeable,  and  yet  richer  in  nutritive  matter  than 
pure  cow's  milk  or  peptonised  milk. 


79 

PEPTONISED    MILK. 

Peptonised  milk,  some  ten  years  ago  practically  un- 
known, is  to-day  by  farthe  most  important  and  the  most  used 
by  the  medical  profession  of  all  foods  for  the  sick.  The 
reason  for  this  is  shown  in  the  great  value  of  milk  as  a 
comprehensive  nutrient,  in  its  availability  and  cheapness. 
In  truth,  a  pint  of  peptonised  milk  contains  more  actual 
peptone,  more  total  nutritive  substances,  than  the  same 
bulk  of  many  so-called  concentrated  beef  elixirs,  wines, 
etc.,  which  cost  a  dollar  per  pint.  Milk  contains  every 
element  of  nutrition  in  a  form  naturally  fitted  for  absorp- 
tion, with  the  exception  of  its  caseine.  Therefore,  it  is 
apparent  that  by  changing  the  caseine  into  soluble  pep- 
tone, we  obtain  an  ideal  food  for  the  sick. 

Caseine  is,  of  all  albuminoids,  the  most  difficult  and 
impracticable  of  artificial  digestion  by  pepsin  and  acid, 
either  as  existing  naturally  in  milk  or  as  separated  there- 
from by  acid  or  rennet,  and  treated  just  as  we  should 
treat  egg  albumen,  fibrin,  etc.  Caseine  is,  moreover, 
unquestionably  more  difficult  of  digestion,  even  in  the 
stomach,  than  other  albuminoids,  such  as  of  fish,  beef, 
egg,  etc. 

It  is  not  a  little  remarkable  that  milk,  "the  type  of  a 
complete  aliment,"  should  prove  so  marvelously  susceptible 
to  artificial  digestion  by  means  of  the  proteolytic  ferment 
of  the  pancreas,  for  thus  the  caseine  of  milk  can  be  at 
will  brought  to  any  desired  degree  of  conversion  without 
rendering  the  milk  repulsive  in  taste  or  appearance.  In 
fact,  peptonised  milk,  when  prepared  according  to  the 
directions  with  the  peptonising  tubes,  is  quite  as  agree- 
able as  raw  milk,  and  better  relished  by  most  persons. 
By  the  "  cold  process  "  no  artificial  taste  whatever  is  im- 
parted to  the  milk.  Peptonised  milk  is  milk  with  its 


80 

caseine  converted  into  peptone  by  the  process  of  arti- 
ficial digestion.  The  object  of  the  directions  given  for 
peptonising  milk  is  to  submit  its  caseine  to  the  action 
of  the  digestive  ferment  under  the  definite  simple  condi- 
tions by  which  it  may  be  digested  to  any  suitable  degree 
of  conversion. 

When  well  peptonised,  the  milk  will  be  found  to  have 
become  thinner  and  of  a  greyish  yellow  color,  and  to  have 
a  slight,  peculiar  and  by  no  means  disagreeable  taste 
characteristic  of  peptonisation.  Wholesome  peptonised 
milk  should  not  have  the  slightest  rancid  flavor  or  odor. 

It  is  very  seldom  necessary  to  peptonise  the  milk  to 
the  point  at  which  the  bitter  taste  is  developed.  It  must 
be  borne  in  mind  that  the  peptonising  process  goes  on  as 
long  as  the  milk  is  warm  ;  therefore  it  is  necessary  to 
transfer  the  bottle  promptly  from  the  warm  bath  to  the 
ice  chest,  in  order  to  check  digestion.  For  various  methods 
of  preparing  peptonised  milk,  for  making  it  an  agreeable 
beverage,  see  Fairchild's  "  Practical  Recipes." 


NUTRITIVE    ENEMATA. 

Peptonised  Foods  are  peculiarly  adapted  for  rectal 
alimentation.  In  the  rectum  is  presented  every  condition 
essential  to  the  conversion  and  complete  absorption  of  the 
peptonised  food,  etc.,  without  irritation  or  complication. 
In  times  past  it  has  been  recommended  to  prepare  beef, 
etc.,  for  enemas  by  mixing  it  into  a  pulp  with  the  fresh 
pancreas  gland.  To-day,  in  the  Extractum  Pancreatis  or 
the  Peptonising  Tubes,  we  have  the  means  of  quickly  and 
conveniently  preparing  milk,  beef,  eggs,  etc.,  as  absorbable 
enemas  capable  of  sustaining  life  for  an  indefinite  time. 


81    • 


MILK    ENEMATA. 

Milk  may  be  introduced  as  soon  as  it  is  mixed  in  the 
ordinary  proportion  with  the  peptonising  powder,  and  as 
it  is  usually  required  warm,  a  very  considerable  degree  of 
pre-digestion  will  take -place  whilst  bringing  the  milk  to 
proper  temperature  ;  or  best,  the  powder  should  be  mixed 
with  ready  warmed  milk. 

Peptonised  milk  may  be  very  conveniently  prepared 
by  the  cold  process,  and  when  required  the  proper 
quantity  may  be  warmed  and  injected. 

EGG    ENEMATA. 

Dissolve  the  white  of  an  egg  in  thrice  its  bulk  of  warm 
water  ;  add  'the  contents  of  a  peptonising  tube  and  stir 
well,  and  inject  at  once.  An  egg,  white  and  yelk,  may  be 
thoroughly  mixed  with  a  pint  of  milk  and  peptonised 
in  the  usual  manner,  and  thus  afford  a  very  nutritious 
enema. 

BEEF    ENEMATA. 

Take  a  tablespoonful  of  minced  lean  beef,  add  to  four 
tablespoonfuls  of  cold  water,  and  gradually  heat  to  boil- 
ing. Now  rub  all  through  a  fine  sieve  or  colander,  and 
when  luke-warm  add  the  contents  of  a  peptonising  tube, 
and  it  is  ready  for  injection.  It  may  be  made  more  fluid 
if  desirable. 

PANOPEPTON    ENEMATA. 

Panopepton  possesses  every  desirable  quality  for  nutri- 
tive enemata.  It  contains  all  the  soluble  and  digestible 
constituents  of  bread  and  beef.  It  is  made  ready  for  use 
simply  by  dilution  with  three  or  four  parts  of  warm  water ; 
is  readily  absorbable  and  non-irritant  and  has  been  used 
with  such  success  as  to  conclusively  demonstrate  its  value. 


PANOPEPTON. 

BREAD    AND    BEEF    PEPTONE. 

Having  been  the  first  to  realise  the  value  and  scope  of 
the  digestive  ferments  as  artificial  agents  of  digestion,  and 
the  originators  of  the  Fairchild  process,  which  has  become 
familiar  in  every  household  for  the  peptonisation  of  food 
for  the  sick,  we  have  not  failed  to  perceive  the  great  need 
for  a  true,  ready-made  peptonised  food.  Peptonised  foods 
by  the  Fairchild  process  have  long  been  recognised  as  su- 
perior to  all  others  available,  the  only  objection  being  the 
necessity  of  preparing  them  fresh  every  day  when  required. 

In  Panopepton  we  present  to  the  profession  a  new, 
complete  and  perfect  peptone,  one  which  we  are  confident 
will  meet  every  requirement.  Panopepton  is  the  entire 
edible  substance  of  prime,  lean  beef  and  best  wheat  flour, 
thoroughly  cooked,  properly  digested,  sterilised  and  con- 
centrated in  vacuo.  The  trimmed  and  cooked  beef  is 
subjected  to  digestion  strictly  to  the  point  of  complete 
solution  of  its  albuminoids  and  the  cooked  wheat  to  the 
solution  of  both  its  gluten  and  starch.  Panopepton  is, 
therefore,  the  quintessence  of  peptones,  containing  all  the 
nutrients  of  these  two  great  types  of  food,  beef  and  bread, 
fused  into  a  delicious  restorative. 

The  superiority  of  peptones  from  cooked  foods  over 
any  form  of  raw,  unsterilised  beef  is  obvious.  Sterilisation 
is  an  essential  feature  of  the  process  for  Panopepton, 
peptones  not  being  coagulable  at  the  boiling  temperature, 
as  are  all  other  forms  of  albuminoids.  Expressed  juice  of 
beef  is  instantly  coagulated  by  heat,  showing  the  fact  that 
its  albuminoids  require  conversion  into  complete  solution 
before  they  are  fit  for  absorption. 

Panopepton  is  completely  soluble  and  absorbable  and 
responds  to  every  test  of  true  peptone  and  will  satisfy  the 
most  exact  and  scientific  scrutiny  as  to  its  qualities  in  every 
particular. 

As  significant  of  the  technical  skill  and  care  with  which 
the  Panopepton  is  prepared,  we  call  attention  to  the  im- 
portant fact  that  it  is  free  from  cane  sugar  or  condiments, 
its  agreeable  flavor  being  purely  characteristic  and  like  that 
of  roast  beef  juice  and  crust  of  bread. 


83 

Digestion  is  a  process  of  solution,  the  slight  mechanical 
operation  concerned,  being  merely  to  expose  increased 
surface  to  the  solvent  action  of  the  digestive  juices.  By 
digestion  only  are  we  enabled  to  convert  into  solution  the 
bulk,  the  actual  substance,  of  food  stuffs  and  thus  fit  them 
for  appropriation  by  the  system.  We  cannot  by  maceration 
or  infusion  with  water,  dissolve  or  extract  the  real  nutritious 
substance  of  beef.  The  starch  (the  carbohydrate)  of  flour 
or  bread,  likewise,  can  be  made  soluble  only  by  digestion. 

Panopepton  contains  not  only  such  extractives,  salts  and 
savory  matters,  as  are  found  in  beef  juices,  beef  tea,  etc., 
but  further  and  peculiarly,  a  solution  of  the  whole  substance 
of  beef  and  bread. 

For  many  years  the  peptonisation  of  beef  and  wheat  has 
been  the  subject  of  experiment  and  study  by  us,  for  we 
considered  that  in  these  combined  albuminoids  and  carbo- 
hydrates only  could  we  seek  for  a  true  and  complete  food. 

If,  for  the  nutrition  of  the  body  in  health,  every  form  of 
alimentary  substance  is  essential,  why  should  we  in  disease 
resort  solely  to  albuminoids  or  digested  albuminoids,  except 
in  the  cases  where  especially  indicated.  The  experience  of 
the  human  race  is  expressed  in  the  saying,  "bread  is  the 
staff  of  life." 

The  rank  which  peptonised  milk  holds  as  a  food  for 
the  sick  is  due  especially  to  the  fact  that  milk  is  the  "  type 
of  complete  aliments," — (Dujardin-Beaumetz)  ;  is  "  com- 
plete in  itself." — (Pavy).  Panopepton  is  the  first  food  for 
the  sick  which  may  be  relied  upon  to  replace  milk,  for  like 
milk,  it  affords  all  the  elements  requisite  for  the  nutrition 
of  the  body. 

The  uses  of  such  a  peptonised  food  product  as  Pano- 
pepton are  so  obvious  that  it  is  only  necessary  to  suggest 
the  directions  in  which  it  will  be  found  of  inestimable 
value.  Panopepton  is  the  food  par  excellence,  for  invalids  ; 
in  all  acute  diseases,  fevers,  etc. ;  in  convalescence  ;  for  the 
large  class  of  persons  who  from  feebleness,  or  deranged 
digestion,  or  antipathy  to  ordinary  foods,  require  a  fluid, 
agreeable  and  quickly  assimilable  food.  As  a  restorative 
from  fatigue,  for  sleeplessness  due  to  care  and  anxiety,  or 
stress  of  mental  work,  Panopepton  is  a  most  potent  recon- 


84 

structive,  to  which  immediate  response  is  felt.  Panopepton 
is  preserved  in  a  sound  sherry,  without  added  alcohol,  and 
is  at  once  a  grateful  stimulant  and  food. 

A  wineglass  of  Panopepton,  with  a  small  biscuit  or 
cracker,  will  be  found  the  best  lunch  or  supper  for  the 
brain  worker,  when  too  tired  for  the  tolerance  or  digestion 
of  ordinary  foods.  For  invalids  travelling  and  under  any 
circumstances  where  it  is  inconvenient  to  prepare  food  foi 
the  sick,  Panopepton  may  be  relied  upon.  In  seasickness 
it  is  especially  acceptable.  Panopepton  will  be  found  to 
be  of  the  most  agreeable  flavor  when  taken  cold,  conse- 
quently we  recommend  keeping  it  in  a  cool  place,  although 
it  will  keep  perfectly  for  an  indefinite  time  under  ordinary 
conditions. 

It  is  obviously  quite  impossible  to  state  an  arbitrary 
dose  of  Panopepton  under  the  wide  range  of  conditions  in 
which  it  is  to  be  employed  ;  for  the  quantity  and  frequency 
of  administration  is  to  be  determined  by  the  indications  of 
each  case.  In  inanition,  due  to  protracted  inability  to 
tolerate  food,  we  have  known  five  drops  of  Panopepton, 
diluted  with  carbonic  water,  and  gradually  increased  up  to 
teaspoonful  doses  every  few  hours,  to  have  fairly  rescued 
the  patient  from  the  last  stages  of  exhaustion.  Its  restora- 
tive effect  under  such  circumstances  has  been  little  short 
of  miraculous. 

Panopepton  presents  not  only  the  best  means  of  resisting 
and  repairing  the  inroads  of  disease,  but  of  restoring  the 
natural  digestive  functions,  and  helping  the  convalescent  to 
resume  a  normal  diet. 

Panopepton  should  not  be  mixed  with  milk  or  any  other 
food,  and  whatever  diet  is  ordered  in  conjunction  there- 
with, the  Panopepton  is  to  be  taken  pure  or  with  cracked 
ice,  carbonic  water  or  wines. 

For  infants  during  summer  complaint,  Panopepton  is  a 
food  rationally  indicated  and  may  be  given  in  doses  from  a 
few  drops  to  half  a  teaspoonful  according  to  circumstances. 

For  adults,  the  usual  portion  should  be  a  dessert  or 
tablespoonful  several  times  a  day  and  at  bedtime. 


85 

THE      SURGICAL      USE      OF     THE     DIGESTIVE 
FERMENTS. 

It  is  a  fact  long  known,  that  the  action  of  the  proteo- 
lytic  ferment  of  the  gastric  juice  is  not  confined  to  purely 
alimentary  substances,  but  is  capable  of  dissolving  albumin- 
ous matter  in  the  various  forms  occurring  in  false  fibrinous 
membrane,  in  sloughing  and  diseased  tissues,  etc. 

"  Gastric  Juice  was  many  years  ago  employed  by  Dr.  P. 
"  S.  Physick,  the  celebrated  surgeon  of  Philadelphia,  with 
"  considerable  success,  as  a  local  application  to  cancers  and 
"  sloughing  ulcers,  with  the  view  of  removing  the  dead  bone 
"  and  flesh,  correcting  the  offensive  odor,  and  yielding  a 
"  healthy  stimulus  to  the  diseased  surface.  It  has  also  been 
"  used  with  success  by  Dr.  Ellsworth,  of  Hartford,  Conn., 
"  for  dissolving  a  portion  of  tough  animal  food,  which  had 
"  become  impacted  in  the  oesophagus  of  a  lad  affected  with 
"  stricture  of  that  passage.  The  gastric  juice  of  a  pig  was 
"  used." — {Boston  Med.  6°  Surg.  J^ourn.,  April  17,  1856.) 

The  purely  physiological  functions  of  the  digestive 
ferments  and  their  application  as  agents  of  digestion 
of  alimentary  substances,  have  naturally  more  engaged 
the  attention  both  of  the  medical  profession  and  those 
who  have  sought  to  perfect  the  means  and  the  method  of 
utilising  them  in  this  most  practical  direction.  Meanwhile 
the  surgical  application  of  the  digestive  ferments  has 
too  long  failed  of  that  attention  which  the  least  sanguine 
estimate  of  their  value  must  show  them  eminently  worthy 
of.  In  recent  years  we  have  given  considerable  atten- 
tion to  this  subject,  and  from  time  to  time  supplied  the 
ferments  in  the  best  form  available  for  this  purpose. 
Medical  literature  shows  the  record  of  the  successful  use 
of  Fairchild's  pancreatic  extract  and  pepsin  in  the  throat, 
in  the  auditory  canal,  in  ulcers,  sloughing  wounds,  in  the 
bladder,  etc.  A  novel  and  most  important  application  of 


86 

the  digestive  ferments  in  gonorrhoea  and  urethral  stricture 
has  been  made  by  a  physician  who  has  found  Extractum 
Pancreatis  the  most  successful  agent.  Applied  dry  it  ad- 
heres to  the  mucous  membrane,  and  finds  sufficient 
moisture  for  its  effective  action.  The  extract  is  pref- 
erably mixed  with  sodium  bi-carbonate — say  i  grain  to  5 
of  the  Extract.  In  this  situation,  as  in  all  others  observed, 
the  ferment  seems  to  exert  no  action  upon  normal  tissue. 
A  record  of  many  cases  has  already  been  made,  and  the 
subject  is  still  under  investigation.  A  case  has  also  been 
reported  to  us  of  the  successful  treatment  of  stricture  of 
the  oesophagus  by  application  of  the  Extractum  Pan- 
creatis with  sodium  bi-carbonate.  In  diphtheria,  we  have 
every  reason  to  believe  that  the  best  results  are  to  be  ob- 
tained by  the  insufflation  of  the  dry  Extractum  Pancreatis 
mixed  with  Sodium  Bi-carbonate  ;  thus  applied,  it  adheres 
well  to  the  mucous  membrane,  which  affords  sufficient 
secretion  as  a  medium  for  the  solvent  action.  Dr.  Robert  T. 
Morris,  a  well-known  surgeon  of  this  city,  seeing  the 
remarkably  successful  use  of  Fairchild's  pepsin,  by 
his  suggestion  in  the  treatment  of  a  crushed  liver,  was 
led  to  undertake  scientific  investigation  and  extended 
practical  trial  of  the  digestive  ferments  as  solvents  in  surgi- 
cal cases.  Subsequently  Dr.  Morris  undertook  a  series  of 
experiments,  to  test  the  solvent  power  of  pepsin  upon 
carious  bone  previously  decalcified  by  subjection  to  dilute 
hydrochloric  acid,  with  the  view  to  remove  dead  bone 
without  subjecting  a  weak  patient  to  a  dangerous  or 
deforming  operation.  Succeeding  in  these  experiments, 
Dr.  Morris  made  practical  use  of  this  new  surgical  resource 
with  complete  success,  the  pepsin  liquefying  the  carious 
bone  and  exerting  no  action  upon  normal  bone. 

The  results  of  Dr.  Morris'  investigations  are  published 
in  the  New  York  Medical  Journal,  April  n,  1891  :  "The 
action  of  pancreatic  extract  and  pepsin  upon  sloughs, 


8? 

Coagula  and  muco-pus  ;"  and  March  19,  1892  :  "The  re- 
moval of  necrotic  and  carious  bone  with  hydrochloric  acid 
and  pepsin."* 

The  grounds  on  which  the  digestive  ferments  are 
applied  in  surgery  are  admirably  stated  by  Dr.  Morris  as 
follows  : 

"It  is  not  easy  to  see  at  a  glance  the  whole  field  for  digestive  fer- 
ments in  surgery,  but  we  know  that  they  are  bland  and  harmless  in  any 
proportion,  and  that  they  will  liquefy  dead  tissues  close  down  to  the  liv- 
ing ones,  and  that  there  their  action  will  end  abruptly." 

From  Dr.  Morris'  paper  the  following  typical  cases 
summarised  : 

"A  resource  was  brought  into  play  a  few  weeks  ago,  when  I  had 
occasion  to  make  suggestions  relative  to  the  treatment  of  a  crushed 
liver.  Portions  of  the  organ,  which  were  dark  and  sloughing,  remained 
so  firmly  attached  that  their  removal  was  dangerous,  and  the  pultaceous 
lining  membrane  of  the  enormous  abscess  seemed  to  invite  all  manner  of 
microbe  guests.  The  idea  of  liquefying  the  dead  tissues  with  a  digestive 
ferment  came  into  mind,  and  this  being  suggested,  was  carried  into 
effect  by  the  family  physician,  who  injected  into  the  abscess  cavity  a 
solution  of  scale  pepsin,  and,  writing  to  me  afterward,  said  :  '  The  pep- 
sin did  mighty  good  work.  It  broke  up  all  dead  tissues,  rendering  them 
mostly  liquid,  and  changed  the  color  from  brown  to  straw-color.  The 
liquefied  substances  were  easily  washed  out  through  the  drainage  tube. 
The  wound  was  sterilised  daily  afterward  with  hydrogen  peroxide,  and 
the  patient  recovered  without  a  bad  symptom."  " 

"  Dr.  C.  N.  Haskell  liquefied  two  grammes  of  tough  lining  membrane 
from  the  tuberculous  abscess  of  a  case  of  hip  joint-disease,  with  pepsin 
in  fifty-five  minutes." 

"  Dr.  C.  D.  Jones,  of  Brooklyn,  poured  a  solution  of  pancreatic  extract 
(pancreatic  extract,  2  dr.;  water  8  ozs.)  into  the  abscess  cavity  of  a  case 
of  hip-joint  disease  one  week  after  the  operation  of  excision  had  been 
performed.  He  then  wrote  me  as  follows  :  '  The  solution  was  allowed 
to  remain  in  place  half  an  hour,  and  the  result  was  remarkable.  Upon 
irrigation,  I  washed  out  numerous  shreds  of  broken-down  ligamentous 
tissue  and  many  spicula  of  dead  bone  that  had  become  imbedded  in  the 

*Reprints  of  these  papers  will  be  sent  on  application  to  us. 


88 

Soft  tissues  and  that  had  previously  escaped  both  irrigator  and  currette. 
The  wound  was  then  flushed  out  with  hydrogen  peroxide,  and  this  treat- 
ment was  followed  by  a  marked  improvement  in  the  patient's  general 
condition.'" 

"  In  one  case  in  which  the  bladder  contained  blood-clots  and  the 
catarrhal  mucous  membrane  discharged  ropy  muco-pus,  pepsin  injected 
for  the  purpose  of  liquefying  the  clots  not  only  fulfilled  its  mission  in 
that  direction,  but  unexpectedly  cleared  out  the  muco-pus  and  left  the 
interior  of  the  bladder  quite  clean.  The  process  was  repeated  as  soon 
as  the  muco-pus  again  became  abundant,  and  the  patient  experienced  a 
feeling  of  relief  after  the  simple  cleansing  that  pepsin  afforded." 

"After  much  experimentation  I  have  finally  adopted  a  method  of  work 
which  seems  to  be  complete.  An  opening  is  made  through  soft  parts  by 
the  most  direct  route  to  the  seat  of  dead  bone,  and  if  sinuses  are  present 
they  are  all  led  into  the  one  large  sinus  if  possible.  The  large  direct 
sinus  is  kept  open  with  antiseptic  gauze  and  the  wound  allowed  to  remain 
quiet  until  granulations  have  formed." 

"Granulation  tissue  contains  no  lymphatics,  and  absorption  of  septic 
materials  through  it  is  so  slow  that  we  have  a  very  good  protection 
against  cellulitis.  The  next  step  consists  in  injecting  into  the  sinus  a  two 
or  three  per  cent,  solution  of  hydrochloric  acid  in  distilled  water.  If  the 
patient  is  confined  to  bed,  the  injections  can  be  made  at  intervals  of  two 
hours  during  the  day  ;  but  if  it  is  best  to  keep  the  patient  up  and  about, 
the  acid  solution  is  thrown  into  the  sinus  only  at  bed-time.  In  either 
case  the  patient  is  to  assume  a  position  favorable  for  the  retention  of  the 
fluid.  Decalcification  takes  place  rapidly  in  exposed  layers  of  dead  bone, 
and  then  comes  the  necessity  for  another  and  very  important  step  in  the 
process.  At  intervals  of  about  two  days  an  acidulated  pepsin  solution  is 
thrown  into  the  sinus  (I  use  distilled  water,  f  §  iv ;  hydrochloric  acid, 
mt  xvj  ;  Fairchild's  pepsin,  3  ss.),  and  this  will  digest  out  decalcified 
bone  and  caseous  or  fatty  debris  in  about  two  hours,  leaving  clean  dead 
bone  exposed  for  a  repetition  of  the  procedure.  The  treatment  is  con- 
tinued until  the  sinus  closes  from  the  bottom,  showing  that  the  dead  bone 
is  all  out." 

"  Even  in  distinctly  tuberculous  cases  the  sinuses  will  close  if  appara- 
tus for  immobilising  diseased  parts  and  tonic  constitutional  treatment  are 
employed,  as  they  should  be  in  conjunction  with  our  efforts  at  removing 
the  dead  bone." 

"  If  suppuration  is  free  in  any  cavity  in  which  we  are  at  work,  it  is 


89 

well  to  make  a  routine  practice  of  washing  out  the  cavity  with  peroxide 
of  hydrogen  before  each  injection." 

Pepsin  is  the  ferment  which  will  probably  give  the  best 
results  in  all  cases  where  the  acid  essential  to  its  operation 
is  not  objectionable,  and  where  the  swelling  of  the  fibrin- 
ous  matter,  which  instantly  occurs  on  contact  with  the 
acid  is  not  an  objection.  This  behavior  of  acid  would 
siometimes  be  considered  unfavorable,  as  in  the  auditory 
canal,  in  the  throat  and  in  the  urethra  ;  but  in  abscess 
cavities,  etc.,  this  is  no  objection — on  the  contrary,  the 
acid  seems  itself  a  salutary  agent,  giving  a  healthy  stim- 
ulus to  the  diseased  surface,  and  is,  moreover,  antiseptic. 
Further,  the  action  of  this  acid-pepsin  digestion  ceases  at 
the  production  of  peptone.  These  pepsin  peptones  do 
not  themselves  readily  undergo  putrefactive  changes 
whilst  the  solution  remains  acid.  The  pancreatic  fer- 
ments acting  upon  all  these  forms  of  proteid  encountered 
in  surgical  cases,  are  very  effective  in  water  without  the 
intervention  of  an  alkali,  but  their  action  is  accelerated  in 
an  alkaline  solution  so  slight  as  one  part  sodium  bicar- 
bonate to  500  of  water.  Moist  fibrin  can  as  quickly  be 
digested  by  Extractum  Pancreatis  plus  alkali  as  with 
pepsin  plus  acid,  by  simply  adjusting  the  quantity  of  the 
ferment  to  attain  the  desired  result.  There  is  no  possible 
cause  for  hesitancy  in  using  the  ferment  as  freely  as 
necessitated  ;  there  is  no  other  effect  than  its  digestive 
action,  which  ceases  when  no  morbid  tissue  remains  to 
work  upon.  The  soda  itself  is  in  many  instances  as 
clearly  indicated  and  as  useful,  for  instance  in  the 
urethra,  in  the  bladder,  in  the  throat,  etc.,  as  the  acid  is  in 
the  cases  suitable  for  pepsin. 

In  the  surgical  use  of  the  digestive  ferments,  it  is 
absolutely  essential  to  follow  as  closely  as  possible  the 
conditions  most  favorable  to  the  action  of  the  particular 
ferment  utilised.  At  the  outset,  probably  no  better 


90 

guidance  can  be  had  than  the  procedure  developed  by 
practical  experience  in  the  use  of  the  digestive  ferments, 
as  applied  in  this  artificial  digestion  of  albuminous  matter 
in  the  test  tube. 

In  using  pepsin,  the  intervention  of  acid,  from  one  half 
to  one  per  cent,  hydrochloric  acid,  U.  S.  P.  to  the  volume 
of  water  is  essential.  Extractum  Pancreatis  may  be  used 
with  simple  water,  or  with  water  rendered  slightly  alkaline 
with  soda  bi-carbonate,  say  5  grains  to  each  fluid  ounce. 

The  surgeon,  then,  in  the  normal  range  of  media  and 
action  of  the  peptic  and  pancreatic  ferments,  is  enabled  to 
use  an  effective  solvent,  either  acid,  neutral  or  alkaline,  as 
best  adapted  to  the  case  in  hand. 

The  most  favorable  temperature  for  the  preparation  and 
for  the  action  of  the  digestive  fluids  can  be  readily  ascer- 
tained by  any  attendant  without  the  use  of  the  thermom- 
eter, by  using  water  heated  to  the  point  at  which  it  can  be 
borne  by  the  whole  hand  (115°  F.),  or  not  too  hot  to  be 
swallowed  with  comfort,  about  130°  F.  This  gives  a  tem- 
perature of  115  or  130°  F.,  at  which  they  act  better  than 
at  the  body  heat,  and  the  water  should  always  be  brought 
to  the  proper  temperature  before  adding  the  digestive  fer- 
ment. This  avoids  all  risk  of  injuring  the  ferment. 

If  there  is  no  cavity  to  hold  the  solvent  in  contact 
with  the  matter  to  be  digested,  the  solvent  should  be 
applied  by  copious  sprays,  frequently  repeated.  In  cav- 
ities, repeated  applications  are  preferable,  as  otherwise  the 
digestive  fluid  may  become  saturated  with  the  products  of 
digestion,  and  thus  cease  to  act.  It  is  also  to  be  noted 
that  the  irrigation  should  follow  as  quickly  as  possible  the 
liquefaction  of  the  tissues. 

The  solvents  should  invariably  be  freshly  prepared  for 
each  application^  as  the  ferments  mixed  with  the  water  are 


91 

Hot  only  prone  to  decomposition  and  to  become  inert,  but 
if  mixed  with  cold  water  and  then  brought  to  the  proper 
temperature  each  time  required,  they  are  very  apt  to 
be  injured  by  overheating.  With  warm  water,  it  is  but  a 
moment's  work  to  prepare  just  the  quantity  required  for 
each  application. 

In  using  pepsin,  we  strongly  recommend  Glyccrinum 
Pepticum,  both  for  convenience  and  efficiency,  as  contain- 
ing the  ferment  in  a  highly  concentrated,  pure  glycerin 
extract,  instantly  soluble  in  any  desired  proportion  and 
especially  convenient  for  spraying. 

GLYCERINUM  PEPTICUM 
AS     A     SURGICAL     SOLVENT. 

In  any  convenient  glass,  mix  one  teaspoonful  of  Glycer- 
inum  Pepticum  with  one  fluid  ounce  of  warm  water,  say  at 
115°  F.,  and  4  drops  acid  hydrochloric  c.  p.  (16  drops  dilute 
acid  U.  S.  P.).  Apply  by  injection,  spray,  etc.,  as  most 
suitable. 

FAIRCHILD'S  PEPSIN 
AS    A    SURGICAL    SOLVENT. 

Mix  5  grains  of  Fairchild's  pepsin  in  powder  perfectly 
smooth  with  a  teaspoonful  of  water,  then  add  an  ounce  of 
warm  water,  stirring  well.  Add  4  drops  acid  hydro- 
chloric c.p.  and  apply  as  required. 

EXTRACTUM  PANCREATIS 

AS 

A  SURGICAL  SOLVENT. 

Mix  in  any  convenient  glass,  5  grains  Extractum  Pan- 
creatis  to  each  fluid  ounce  of  warm  water,  first  carefully 


92 

stirring  the  powder  with  a  teaspoonful  of  the  water,  to  a 
perfectly  smooth  mixture.  At  the  option  of  the  surgeon, 
soda  bi-carbonate,  about  5  grains  to  each  fluid  ounce, 
may  advantageously  be  added. 

It  is  by  no  means  essential  that  these  or  any  arbitrary 
proportions  shall  be  observed.  These  quantities  specified 
can  be  readily  approximated  without  weighing.  If  it  is 
found  desirable  to  write  a  prescription  for  the  solvents, 
the  following  formulas  will  be  found  satisfactory  : 

Glycerinum  Pepticum 2  fl.  ozs. 

Acid  Hydrochloric  c.p 64  minims. 

Aqua-Destillata 6  fl.  ozs. 

M,  S.  Pour  the  quantity  necessary  for  each  application 
into  an  equal  quantity  of  water,  heated  to  about  115°  F., 
or  as  hot  as  can  be  borne  by  the  whole  hand  and  apply  as 
directed. 

Extractum  Pancreatis 3  drs. 

Soda  Bi-carb i  dr. 

M,     Divide  in  wax  papers  No.  12. 

Mix  one  powder  with  a  gill  of  warm  water  and  prepare 
fresh  for  each  application  as  directed. 

In  preparing  these  solvents  with  water,  it  is  well  to 
use  that  which  has  been  well  boiled  or  distilled. 

Extractum  Pancreatis i  dr. 

Soda  Bi-carb 15  grains. 

M,  Divide  in  wax  papers  No.  12.    Apply  dry  as  directed. 


FAIRCHILD'S 

PEPTOGENIC  POWDER  AND  PROCESS; 

ITS   DEVELOPMENT   AND   RATIONALE. 


It  is  now  nearly  ten  years  since  we  introduced  a 
method  of  preparing  an  imitation  of  woman's  milk,  based 
upon  the  agency  of  a  digestive  ferment  in  effecting  the 
physiological  conversion  of  the  caseine  of  cows'  milk  into 
the  soluble  and  diffusible  form,  in  which  the  albuminoids 
exist  in  human  milk. 

This  purely  physiological  action  of  the  digestive  fer- 
ment can  be  controlled  or  checked  at  will  by  regulating  the 
temperature  to  which  the  ferment  is  subjected.  Under 
favorable  conditions,  the  ferment  acts  until  its  power  is 
spent;  by  simply  raising  the  temperature  of  the  digesting 
mixture  to  about  160°  F.,  it  is  instantly  destroyed  and 
thus  becomes  an  inert  substance,  insignificant  in  amount 
and  resembling  in  chemical  and  physiological  properties 
so  much  albumen. 

The  digestive  ferment  has  no  other  action,  no  proper- 
ties at  all  comparable  to  those  of  a  drug  or  chemical. 

The  pancreas  ferment,  trypsin,  has  a  remarkable  affinity 


94 

toward  milk,  digesting  its  caseine  with  great  rapidity  with- 
out altering  its  other  elements  and  without  rendering  the 
milk  repulsive.  Milk  so  treated  is  known  as  "  peptonised 
milk  "  and  as  made  available  by  the  Fair  child  products  and 
process,  has  long  since  become  the  chief  reliance  of  the 
medical  profession  as  supplying  an  ideal  food  for  the  sick. 

The  value  of  peptonised  milk  was  immediately  recog- 
nised as  a  resource  for  the  feeding  of  an  infant  with  natur- 
ally feeble  or  disordered  digestion,  and  experience  only 
confirmed  the  promise  of  its  great  usefulness. 

After  some  years  of  practical  experience  with  the  pepto- 
nising  process,  and  seeing  the  great  facility  with  which 
caseine  could  be  brought  to  any  desired  degree  of  digestion, 
the  idea  occurred  to  us  that  this  process  promised  the 
solution  of  the  problem  of  preparing  an  adequate  substitute 
for  woman's  milk;  as  opening  the  way  for  the  qualitative  and 
quantitative  adjustment  of  cows'  milk  to  a  correspondence 
with  human  milk  to  a  degree  never  before  attempted. 

In  order  to  prosecute  the  undertaking,  we  entrusted  the 
necessary  expert  investigation  to  Dr.  Albert  R.  Leeds,  well 
known  to  have  made  especial  study  of  the  composition  of 
human  milk  and  of  the  infant  foods. 

Dr.  Leeds  found  that  under  the  influence  of  the  diges- 
tive ferment,  the  caseine  could  be  so  altered  as  to  impart  a 
new  and  peculiar  property  to  the  milk ;  that  the  milk 
became  in  its  physical  characteristics,  density,  color,  taste, 
and  in  its  behavior  with  acids  and  with  gastric  juice, 
remarkably  like  mothers'  milk.  The  albuminoids  of  this 
converted  milk  under  analysis  showed  a  close  resemblance 
to  the  albuminoids  of  woman's  milk,  thus  adding  a  final  proof 
to  the  theory  that  the  differences  in  the  physical  properties 
and  in  the  behavior  and  digestibility  of  cows'  and  human 
milk,  are  directly  dependent  upon  the  character  of  their 
albuminoids. 


95 

Here  then  was  an  agent  for  the  physiological  conversion 
of  the  caseine,  an  expedient  far  more  effective,  natural  and 
convenient  than  any  hitherto  devised,  and  which  made 
possible  the  construction  of  an  artificial  human  milk,  by 
carrying  out  the  further  important  modifications  indicated 
by  the  results  of  comparative  analysis. 

As  a  final  result,  we  were  able  to  offer  the  Peptogenic 
Milk  Powder  and  method  which  were  found  by  Dr.  Leeds, 
as  stated  in  his  report,  "  to  yield  a  '  humanised  milk '  which 
in  physical  characteristics  and  chemical  constitution 
approaches  very  closely  to  woman's  milk."  Thus  we  intro- 
duced a  method  of  preparing  a  substitute  for  mothers' 
milk,  which  is  the  direct  result  of  scientific  study  and  investi- 
gation and  which  fairly  represents  the  present  status  of 
knowledge  and  attainment ;  the  only  food  for  infants  which 
in  its  development  and  accomplishment,  conforms  to  the 
universally  accepted  postulate  that  the  best  artificial  food 
for  an  infant  is  that  which  in  the  highest  degree  resembles 
mothers'  milk. 

After  ten  years  of  practical  experience,  study,  and 
investigation  since  its  introduction,  during  which  time  we 
have  had  abundant  means  of  ascertaining  the  results  of  its 
actual  use  as  an  exclusive  substitute  for  mothers'  milk,  we 
feel  the  strongest  conviction  that  it  affords  an  artificial  food 
for  infants  which  is  entirely  adequate  for  the  nourishment 
and  development  of  an  infant  during  the  nursing  period. 
We  have,  during  these  years,  given  unremitting  investiga- 
tion in  every  direction  which  might  enable  us  to  attain  the 
utmost  perfection  of  detail  in  the  approximation  to  the 
natural  food  of  an  infant. 

We  submit  the  Peptogenic  Powder  and  method  solely 
upon  this  ground, — as  a  scientific,  practical  and  successful 
method  of  modifying  cows'  milk  to  the  known  composition 


96 

of  human  milk.  Upon  this  ground,  we  ask  the  considera- 
tion of  every  physician  interested  in  providing  food  for 
infants  deprived  of  breast  milk. 

THE  POINT  OF  VIEW  ON  INFANT  FOODS. 

In  infant  feeding,  as  in  many  other  subjects,  scientific 
standards  are  in  advance  of  practical  usage.  So  whilst 
everywhere  it  is  premised  that  mothers'  milk  is  the  best 
food  for  an  infant,  we  see  that  foods  which  are  wholly  made 
up  of  substances  foreign  to  milk,  foods  which  were  never 
designed  to  resemble  human  milk,  continue  to  be  bought 
and  used  without  a  question  as  to  how  they  resemble  the 
food  for  which  they  are  to  be  substituted. 

We  ask  the  physician  therefore  to  submit  the  infant 
foods  of  the  shops  to  the  practical  point  of  inquiry.  How 
do  they  resemble  mothers'  milk  when  prepared  for  the 
nursing  bottle  ?  No  "  infant  food  "  as  it  is  found  in  com- 
merce, resembles  mothers'  milk,  or  can  take  the  place  of  it. 

The  "  infant  foods  "  of  commerce  may  be  fairly  divided 
into  two  distinct  classes  : 

First — Those  which  do  not  contain  any  milk  and  which 
are  to  be  made  ready  for  the  nursing  bottle  by  admix- 
ture with  cows'  milk. 

Second — Those  which  contain  milk,  the  dried  and  condensed 
milk  foods,  all  of  which  are  directed  to  be  prepared  for 
the  nursing  bottle  simply  by  the  addition  of  water. 

When  mixed  for  use  according  to  the  "directions  "  of 
the  manufacturer  the  "infant  foods"  differ  from  human  milk 
obviously  in  physical  properties,  and  by  analysis  will  be 
found  invariably  deficient  in  milk  fat,  milk  sugar  and  milk 
salts,  which  deficiency  is  not  by  any  means  compensated 
for  by  the  malt  sugar  or  baked  flour  which  imparts  thick- 
ness and  sweetness  to  the  food. 


97 

Another  important  question  is : — Shall  we  use  fresh 
milk  or  commercial  milk  products  as  the  basis  for  the  prepa- 
ration of  an  infant  food  ? 

From  our  standpoint,  we  can  at  present  find  no  other 
basis  than  fresh  milk,  for  we  have  not  thus  far  found  that 
milk  can  be  so  treated  as  to  afford  a  stable  commercial  pro- 
duct, from  which  a  close  approximation  to  mothers'  milk 
can  be  prepared. 

We  hold  to  the  view  that  milk  is  materially  altered  by 
drying.  That  it  will  not  on  the  addition  of  water,  have  re- 
stored to  it  even  the  physical  characteristics  of  the  original 
milk  ;  that  the  dried  caseine  of  the  milk  will  not  again  dis- 
solve in  the  water ;  that  the  milk  fat  cannot  be  dried 
successfully  ;  that  it  will  in  this  state,  soon  become  rancid. 

It  has  for  these  reasons  never  been  found  possible  to 
dry  pure  unskimmed  milk  as  a  marketable  product,  even 
for  ordinary  culinary  and  dietetic  purposes. 

Milk  condensed  without  sugar  or  other  preservative  has 
been  found  apt  to  spoil  quickly  after  the  package  is  opened. 
Sweetened  condensed  milk  contains  a  large  amount  of  cane 
sugar  and  when  such  milk  is  diluted  with  the  proper 
amount  of  water,  it  is  much  too  sweet  and  thick.  It  is  in 
common  practice  diluted  so  as  to  be  greatly  deficient  in  the 
real  elements  of  milk. 

COWS'  MILK  AS  A  FOOD  FOR  INFANTS. 

In  seeking  a  food  for  an  infant  deprived  of  breast  milk, 
cows'  milk  has  been  instinctively  resorted  to  as  the  sub- 
stance nearest  to  it  in  apparent  properties  and  design.  But 
notwithstanding  these  similarities,  cows'  milk  has  proven 
inherently  indigestible  for  the  infant  stomach  and  inade- 
quate to  replace  woman's  milk.  Hence  the  problem  of  infant 
feeding.  Hence  the  infant  foods  of  commerce.  Finding 
that  cows'  milk  forms  an  indigestible  curd,  various  expedients 


98 

have  been  employed  to  overcome  this.  Among  these,  is 
the  use  of  an  alkali  such  as  lime  water,  to  form  soluble 
or  alkaline  albuminates,  to  give  the  milk  an  alkaline  reaction 
and  also  to  retard  the  curdling  action  of  the  gastric  juice. 

The  most  familiar  and  common  method  has  been  to 
thicken  milk  with  baked  flour,  or  farinaceous  foods — to 
keep  the  curds  from  forming  a  mass.  But  the  effect  of 
these  substances  is  purely  mechanical,  they  do  not  alter 
the  character  of  the  caseine,  they  "  thicken,"  but  do  not 
enrich  milk.  It  is  simply  adding  a  new  difficulty  without 
overcoming  the  original  one. 

Liebig,  seeing  that  starch  was  not  suited  to  an  infant's 
digestion,  that  the  nursing  infant  is  not  endowed  with  the 
power  to  digest  starch,  proposed  to  utilise  the  starch  digest- 
ing ferment  of  malt — its  diastase — for  the  artificial  diges- 
tion of  starch.  Thus  he  gave  us  the  method  of  treating 
wheat  flour  with  a  fresh  infusion  of  malt  and  bicarbonate 
of  potash,  by  which  the  starch  is  dissolved  and  converted 
into  malt  sugar.  This,  in  brief,  is  the  origin  of  the  Liebig 
foods,  by  which  we  are  now  supplied  with  a  ready-made 
malted  or  digested  flour  for  addition  to  fresh  milk. 

But  there  being  no  starch  nor  digested  starch  (maltose, 
dextrins,  etc.)  in  milk,  human  or  animal,  whilst  there  is 
in  all  milk  found  available  a  sugar  peculiar  to  milk  alone, 
there  remains  neither  reason  nor  necessity  for  giving  starch 
or  digested  starch  to  the  nursing  infant. 

Therefore,  from  the  standpoint  of  to-day,Liebig's  method 
cannot,  on  theoretical  grounds,  be  considered  to  afford  an 
approximation  to  mothers'  milk,  nor  has  it  in  long  practical 
experience  proven  a  solution  of  the  problem  of  infant 
feeding. 

In  the  futile  attempt  to  overcome  the  indigestibility  of 
caseine,  milk  has  often  been  so  diluted  as  to  render  it  in- 
capable of  properly  nourishing  an  infant.  The  addition  of 


99 

water  does  not  alter  the  character  or  behavior  of  caseine. 
Many  in  diluting  the  milk,  have  added  nothing  to  attempt 
to  compensate  for  the  dilution  of  the  sugar  and  the  fat, — 
at  the  beginning  deficient  in  quantity. 

Such  in  brief,  are  the  methods  long  in  practice  for  the 
preparation  of  fresh  cows'  milk  for  infants.  So  that  whilst 
the  selection  of  animal  milk  for  the  bottle  feeding  of  infants 
has  been  dictated  by  its  resemblance  to  the  natural  food, 
we  have  gone  on  adding  to  it  substances  foreign  to  all  milk 
and  unsuited  to  the  digestive  functions  and  nutrition  of  an 
infant. 

It  has  taken  us  a  long  time  to  get  to  the  present  stand- 
point, that  "an  infant  food  approaches  perfection  in  the 
degree  in  which  it  resembles  human  milk." 

If  many  infants  have,  by  virtue  of  superior  resistance, 
been  capable  of  appropriating  sufficient  nourishment  from 
cows'  milk  in  the  various  forms,  how  many  have  perished 
by  artificial  feeding  !  It  is  not  here  necessary  to  "  make  a 
oase  "  in  order  to  offer  a  remedy. 

COMPARATIVE    COMPOSITION    OF    COWS'    AND 
HUMAN    MILK. 

Modern  chemical  and  physiological  investigation  clearly 
reveals  the  reason  why  cows'  milk  is  not  suitable  for  the 
human  infant.  We  see  the  significance  of  the  difference 
found  to  exist  in  the  composition  of  human  and  cows'. milk, 
— that  the  milk  of  each  is  peculiarly  adapted  for  the  purpose 
for  which  it  is  designed.  We  now  know  that  cows'  and 
human  milk  differ  in  the  total  quantity  of  nutritious  mate- 
rials and  in  their  relative  proportions.  Cows'  milk  contains 
less  total  solids,  less  fat,  less  milk  sugar  and  twice  as  much 
albuminoids.  In  cows'  milk,  there  is  a  larger  proportion 
of  the  element  of  nutrition  which^creates  and  supports 


100 

muscular  energy  and  activity  ;    in  human  milk  there  is  a 
larger  proportion  of  sugar  and  fat. 

Breast  milk  is  uniformly  and  persistently  alkaline. 
Cows'  milk  is  more  or  less  acid,  and  its  acidity  becomes 
more  and  more  marked  by  keeping. 

In  cows'  milk  the  greater  part  of  the  albuminoids  is 
caseine,  the  substance  which  is  curded  by  rennet  and  pre- 
cipitated by  acid — the  cheesy  portion. 

In  woman's  milk  the  greater  part  of  the  albuminoids 
exists  in  a  soluble  or  peptone-like  form,  which  is  incapable 
of  coagulation  or  precipitation.  The  small  fraction  that  is 
coagulable  gives  with  acid  or  gastric  juice  minute,  mobile, 
flocculent  particles. 

Thus  it  appears  that  in  cows'  milk  there  is  not  only  a 
preponderance  of  albuminoids,  but  their  quality  is  such  as 
to  demand  a  degree  of  digestive  power  to  which  the  infant 
organism  is  unequal. 

Milk  is  a  vital  secretion,  and  human  milk  the  more 
highly  elaborated,  in  its  digestibility  and  its  nutritive 
qualities,  in  conformity  with  the  requirements  of  the  highly 
organised  being  for  whose  nutrition  it  is  destined. 

It  is  the  caseine,  therefore,  which  has  proven  the  obsta- 
cle to  the  practical  employment  of  milk  as  a  food  for  infants, 
for  the  sugar  and  the  fat  of  milk  exist  in  a  form  ready  for 
absorption — and  in  a  form  peculiar  to  milk  alone. 

THE      USE      OF      THE     PEPTOGENIC      MILK      POWDER 

FOR  THE  PREPARATION  OF  "HUMANISED  MILK" 

INVOLVES   THREE    DISTINCT    STEPS: 

.  First — To  prepare  with  Peptogenic  Powder,  cows'  milk, 
water  and  cream,  a  mixture  which  has  the  quantitative 
composition  of  average  human  normal  milk. 


101 

Second — To  subject  this  mixture  to  the  action  of  the  digestive 
principle  by  which  the  albuminoids  (caseine,  etc.)  are 
converted  into  such  form  as  to  become  identical  with 
those  of  human  milk. 

Third — To  then  destroy  the  digestive  ferment  by  simply 
raising  the  temperature  of  the  milk  to  the  boiling 
point.  This  heat  also  destroys  the  bacteria  and  ren- 
ders the  milk  practically  sterile  during  the  time 
required  for  use — 24  hours. 

DIRECTIONS    FOR   "HUMANISED    MILK." 

No.   i. 

FOR     THE     DAILY     FOOD     OF    A    HEALTHY    NURSING    INFANT. 

Put  into  a  clean  granite  ware  or  porcelain  lined  saucepan, 
four  small  measures*,  or  one  large  measure  of  the  Peptogenic 
Powder,  half  pint  of  cold  water,  half  pint  of  cold  fresh 
milk,  and  four  tablespoonfuls  of  cream.  Place  the  sauce- 
pan on  a  hot  range  or  gas  stove  and  heat  with  constant 
stirring  until  the  mixture  boils.  The  heat  should  be  so  ap- 
plied as  to  make  the  milk  boil  in  ten  minutes 

Keep  in  a  clean,  well-corked  bottle  in  a  cold  place. 
When  needed,  shake  the  bottle  and  pour  out  the  desired 
portion  and  heat  to  the  proper  warmth  for  feeding — luke- 
warm. 

No.  2. 

SPECIALLY     PREPARED     FOOD     FOR     INFANTS     WITH     FEEBLE 

DIGESTION    OR    WHEN    SUFFERING    FROM    DISORDERED 

STOMACH    AND    BOWELS,    AS    IN     CHOLERA 

INFANTUM,     ETC. 

Put  into  a  clean  bottle,  four  small  measures*,  or  one  large 
measure  of  the  Peptogenic  Powder,  half  pint  of  cold  water, 
half  pint  of  cold,  fresh  milk  and  four  tablespoonfuls  of  cream. 

*  Each  large  can  of  Peptogenic  Milk  Powder  contains  a  large  and  a  small 
measure.  Put  the  Powder  into  the  measure  with  the  blade  of  a  knife,  shaking  it 
down  firmly  so  as  to  well  and  evenly  till  the  measure. 

The  small  can  contains  the  small  measure  only. 


Shake  well,  place  the  bottle  in  a  pail  or  tin  kettle  of  water 
(at  least  a  gallon)  as  hot  as  can  be  borne  by  the  whole  hand 
(115°  F.),  and  keep  the  bottle  there  for  30  minutes. 
Then  pour  all  into  a  sauce  pan  and  quickly  heat  to  boiling 
point  with  constant  stirring. 

Keeping  and  feeding  in  the  same  way  as  directed  in 
No.  i. 

COMPOSITION  OF  "  HUMANISED  MILK." 

"  Humanised  milk  "  contains  the  amount  of  milk  sugar, 
fat,  albuminoids,  ash  and  water  found  in  mothers'  milk.  It 
possesses  the  peculiar  alkaline  reaction  due  to  the  proper 
proportions  of  those  various  mineral  and  saline  constituents 
which  are  always  normally  present  in  woman's  milk,  and 
which  are  essential  elements  in  the  nutrition  of  the  infant, 
being  vitally  necessary  to  the  development  of  its  osseous 
system.  It  resembles  mothers'  milk  remarkably  in  its 
physical  properties,  and  under  every  known  method  of  test, 
it  is  found  to  behave  in  the  manner  characteristic  of  aver- 
age normal  breast  milk. 

We  do  not  advise  varying  the  proportions  according 
to  the  age  of  the  child.  In  the  careful  study  of  the  facts 
brought  out  by  the  many  analyses  now  extant  of  woman's 
milk,  made  during  the  entire  period  of  lactation,  there  does 
not  appear  a  sufficient  variation  in  the  quality  of  the  milk, 
or  in  the  ratio  of  its  constituents,  to  afford  a  practical 
ground  for  making  any  variation  in  an  artificial  food. 

It  may  logically  be  assumed  therefore,  that  the  average 
composition  of  human  milk  is  the  most  practical  and  scien- 
tific basis  for  the  fabrication  of  a  food  for  the  average 
infant,  permitting  the  bottle-fed  infant,  like  the  nursing 
infant,  to  take  food  in  such  quantities  and  at  such  inter- 
vals as  best  conduces  to  its  health. 


103 
DIGESTIBILITY  OF  "HUMANISED  MILK." 

"Humanised  milk"  presents  to  the  infant's  stomach  a  food 
which  requires  the  same  exercise  of  the  natural  digestive 
functions  as  required  for  mothers'  milk — the  caSeine  has 
undergone  no  greater  amount  of  artificial  digestion  than  is 
necessary  to  bring  it  to  the  soluble  condition  characteristic 
of  the  albuminoids  of  mothers'  milk.  It  is  not  in  the  least 
giving  a  milk  unnaturally  easy  of  digestion.  There  enters 
the  infant's  stomach  no  artificial  aid  to  digestion,  no  pep- 
sin, no  digestive  ferment  of  any  kind  ;  for  after  the  ferment 
has  accomplished  a  certain  work  in  the  conversion  of  the 
caseine,  it  is  then  destroyed  and  has  no  further  influence 
upon  the  food — has  nothing  more  to  do  with  the  digestion 
of  the  milk  in  the  stomach  than  has  the  fire  by  which  the 
milk  was  heated. 

HOW    TO    ADAPT    THE    MILK    FOR    INFANTS 
WITH  FEEBLE  DIGESTION. 

In  order  to  adapt  this  "  humanised  milk  "  to  the  stomach 
of  an  infant  with  naturally  feeble  digestion,  or  with  diges- 
tion disordered  by  teething,  summer  complaint,  etc.,  the  food 
is  not  to  be  specially  diluted,  it  is  simply  necessary  to  reg- 
ulate the  degree  of  conversion  of  the  caseine  to  insure  its 
digestion  and  assimilation.  This  is  accomplished  by  leav- 
ing the  milk  for  a  longer  time  at  the  temperature  suitable 
for  the  action  of  the  ferment  before  boiling  the  milk. 
Therefore  in  directions  No.  2,  we  direct  30  minutes  in  the 
warm  water  bath  before  bringing  the  milk  to  the  boiling 
point.  In  extreme  cases,  the  caseine  may  be,  by  longer 
digestion,  (40  to  50  minutes)  so  converted  into  a  soluble 
form  that  the  milk  becomes  capable  of  absorption  with- 
out the  least  tax  upon  the  stomach. 

As  the   child   recovers  strength,    the   degree    of   this 


104 

conversion  is  gradually  decreased  until  it  is  able  to  assimi- 
late milk  which  has  the  digestibility  of  mothers'  milk.  By 
this  means  a  sick  infant  is  not  deprived  of  nutrition  in  the 
attempt  to  find  a  food  which  it  can  tolerate. 

There  is  also  another  expedient  which  has  been  found 
successful  in  the  many  cases  of  infants  who  seem  to  have 
practically  no  digestive  power.  This  is  to  give  the 
"humanised  milk"  containing  the  ferment  in  an  active  form 
and  thus  capable  of  effecting  the  subsequent  changes  of 
the  food  essential  to  its  assimilation.  Mix  the  Peptogenic 
Powder,  water,  milk  and  cream  in  the  regular  proportions, 
cold,  then  place  the  bottle  directly  on  ice.  When  required, 
shake  well,  pour  out  only  the  necessary  quantity  and  heat 
carefully  over  a  flame  until  it  is  just  warm  enough  for  the 
nursing  bottle.  Do  not  boil  it  and  do  not  let  it  get  hotter 
than  is  agreeable  to  the  mouth.  This  method  should 
always  be  used  when  the  food  by  Directions  i  or  2  is  not 
properly  assimilated  by  the  infant.  After  the  child  has 
become  strong  enough,  then  gradually  return  to  Directions 
No.  i. 

CHOLERA  INFANTUM. 

The  Peptogenic  Milk  Powder  is  too  often  brought  first 
into  use  in  a  case  when  the  infant  is  suffering  from  cholera 
infantum  or  from  severe  disturbances  of  digestion,  aggra- 
vated by  improper  food  and  the  system  weakened  by  lack  of 
nutrition.  Even  in  such  cases,  relief  is  often  immediately 
found  in  the  administration  of  the  specially  prepared 
"humanised  milk."  (See  directions  No.  2).  Give  very  slowly 
and  in  very  small  quantities  at  each  feeding.  But  many 
times  the  case  presents  the  entire  alimentary  tract  in  a 
condition  highly  favorable  to  the  fermentation  of  milk  and 
equally  unfavorable  to  its  absorption.  Hence,  milk  may 
add  fuel  to  fire. 


105 

In  consequence  of  these  facts  it  has  become  the  prac- 
tice to  discontinue  milk  entirely  for  a  time,  in  the  endeavor 
to  give  rest  to  the  digestive  functions  and  to  promote  the 
effects  of  the  purely  medicinal  measures.  The  difficulty 
here  is  to  find  a  substitute  for  milk  which  will  afford 
adequate  nutrition. 

WHEY  AS  THE  TEMPORARY  FOOD  IN 
CHOLERA  INFANTUM,  ETC. 

"We  strongly  recommend  "  Whey  "  as  affording  by  far 
the  most  satisfactory  temporary  food  in  Cholera  Infantum. 

This  opinion  is  based  not  only  upon  its  composition, 
but  also  upon  some  seven  years  of  practical  experience  of 
its  use.  Whey  contains,  in  a  greater  or  less  degree,  every 
element  of  nutrition  and  in  a  perfectly  assimilable  form. 
It  contains  the  soluble  albuminoids,  milk  sugar  and  saline 
constituents  of  the  milk.  It  is  thus  not  giving  a  diluted 
milk.  The  milk  has  only  been  deprived  of  itscaseine  and 
the  greater  portion  of  its  fat.  Whey  is  therefore  unques- 
tionably far  more  suitable  for  the  nourishment  of  a  child 
than  beef  juices,  beef  foods,  etc.,  or  any  other  food  which  has 
ever  been  suggested  as  a  temporary  substitute  for  milk. 
As  prepared  with  Fairchild's  Essence  of  Pepsine,  it  is x  not 
only  most  palatable,  but  the  contained  Essence  is  also  of 
great  value  as  a  remedy.  For  very  young  infants,  it  should 
be  prepared  with  one  teaspoonful  of  Essence  to  a  pint  of 
warm  milk.  For  older  infants  it  may  be  prepared  with  a 
teaspoonful  to  a  half  pint  of  milk  and  thus  the  proportion 
of  the  Essence  of  Pepsine  may  be  made  available  for  its 
remedial  properties  in  conjunction  with  the  whey.  The 
Essence  of  Pepsine  is  accompanied  by  simple  directions 
for  the  preparation  of  whey.  Whey  should  be  given 
from  the  nursing  bottle,  like  the  ordinary  food. 


lor, 

The  Essence  of  Pepsine  affords  the  ideal  digestive  and 
carminative  stimulant  for  disorders  of  infant  digestion.  It 
is  generally  given  in  5  to  10  drop  doses  in  a  teaspoonful 
of  pure  water  or  with  a  teaspoonful  of  the  whey  or 
"humanised  milk." 

HOW    LONG    SHOULD   THE    BABY    BE    FED    ON 
"HUMANISED    MILK." 

Only  that  food  is  a  proper  substitute  for  breast  milk 
which  is  capable  of  the  nutrition  of  an  infant  during  the 
entire  nursing  period.  "Humanised  milk,"  being  equivalent 
to  average  healthy  breast  milk,  should  be  the  exclusive 
food  of  an  infant  just  as  long  as  it  wou,ld  ordinarily  take 
breast  milk.  The  soundness  of  this  theory  and  this 
practice  has  been  proven  by  experience — by  results. 

It  is  found  that  there  is  a  disposition  on  the  part  of 
parents  to  hurry  the  child  along  to  what  they  fancy  to  be 
a  "  richer  "  food,  to  milk  "thickened  "  with  prepared  foods, 
etc.  To  which  we  reply  that  "humanised  milk"  is  not  de- 
ficient in  any  element  for  the  perfect  development  of  an 
infant,  that  it  is  as  rich  as  human  milk,  and  richer  than 
cows'  milk  in  every  constituent  save  the  caseine  ;  that 
mothers'  milk  ought  to  be  the  safest  standard  for  a  food 
up  tp  the  time  of  weaning. 

HOW  TO  WEAN  THE  BOTTLE-FED  BABY. 

An  infant  should  be  weaned  from  the  bottle  gradually 
just  as  from  the  breast.  At  an  age  at  which  a  nursing 
child  would  ordinarily  be  given  a  little  oatmeal,  hominy 
or  rice,  the  bottle-fed  infant  should  be  given  these  fari- 
naceous foods. 

Begin  with  one  feeding  a  day  of  well  boiled  oatmeal  or 
rice,  or  some  well  baked  potato  mixed  with  "  humanised 
milk."  Feed  with  a  spoon.  Increase  gradually  to  several 


107 

times  a  day,  or  until  the  bottle  is  no  longer  required.  Now 
begin  to  prepare  the  food  with  ordinary  pure  fresh  cows' 
milk  instead  of  with  the  "  humanised  milk"  until  you  accus- 
tom the  child  to  live  entirely  upon  pure  milk  and  farinaceous 
foods.  But  the  less  meat  the  better,  until  the  child  is  two 
or  three  years  old,  say  many  of  the  physicians  most  expert 
in  infant  feeding. 

"HUMANISED    MILK" 

AS    A    PARTIAL    SUBSTITUTE    FOR    BREAST    MILK. 

In  many  cases  it  is  found  desirable  or  necessary  to 
resort  to  bottle-feeding  as  a  partial  substitute  for  breast 
milk;  here  the  "humanised  milk"  is  the  only  food  which 
can  be  properly  given. 

It  is  so  identical  with  pure  breast  milk  that  no  injury 
results  to  the  child,  it  is  taken  as  readily  as  the  breast 
milk,  and  this  alternate  feeding  produces  no  disturbance 
of  the  digestive  functions.  It  is  so  much  better  than  faulty 
breast  milk,  that  it  is  often  of  the  greatest  value,  both  to 
the  infant  and  mother  to  resort  partially  to  a  food  which 
properly  nourishes  the  child  and  relieves  the  mother  of  an 
undue  tax  upon  her  strength.  No  good  result  can  come 
from  compelling  a  child  to  take  several  times  a  day,  thick, 
sweet  malt  sugar  or  starchy  food,  foods  which  load  and 
distend  the  stomach,  and  the  rest  of  the  time  the  thin,  di- 
gestible fluid — mother's  milk. 

Many  a  mother  would  gladly  and  profitably  be  relieved 
in  a  measure  of  the  strain  of  nursing,  if  it  could  be 
accomplished  without  prejudice  to  the  child,  and  this  can 
be  done  by  means  of  "humanised  milk." 

"HUMANISED  MILK"  HAS  NO  SPECIAL  EFFECT 
UPON   THE   BOWELS. 

The  "  humanised  milk "  has  no  especial  tendency  to 
produce  either  costiveness  or  looseness  of  the  bowels. 


108 


Either  one  of  these  conditions  may  appear  according  to 
the  constitution  of  the  child  or  as  dependent  upon  various 
reasons,  just  as  may  occur  when  taking  breast  milk. 
Sometimes — especially  in  hot  weather — an  infant  requires 
water  to  keep  its  bowels  in  good  order  and  for  its  well 
being  in  general.  A  little  calcined  magnesia  or  a  little 
flake  manna  dissolved  in  the  milk  when  ready  for  feeding, 
is  a  good  remedy  for  constipation.  Or  use  oatmeal  water 
in  place  of  plain  water  in  preparing  the  "  humanised 
milk."  Take  one  table-spoonful  of  thoroughly  cooked 
oatmeal  (as  ordinarily  prepared  for  the  table)  and  stir 
well  into  half  a  pint  of  hot  water  ;  strain.  Constipation  is 
sometimes  immediately  relieved  by  heating  the  milk  to 
170°  F.  instead  of  to  the  boiling  point  ;  this  lower  tempera- 
ture is  equally  effective  in  killing  the  digestive  ferment 
and  in  sterilising  the  milk.*  Hold  the  fresh  milk  mixture 
in  a  saucepan  over  a  flame,  stirring  constantly  till  it  is 
heated  to  130°  F.,  remove  from  heat  for  three  to  five 
minutes,  then  place  over  the  flame  again  and  stir  constantly 
till  the  milk  reaches  170°  F. — the  whole  process  not  to  take 
more  than  10  minutes.  Then  pour  the  milk  into  a  clean, 
well-corked  bottle. 

One  of  the  most  simple  and  frequently  effective  expe- 
dients for  loose  bowels  is  to  thicken  the  milk  for  a  few 
feedings  with  thick  arrowroot  gruel,  made  by  mixing  the 
arrowroot  with  cold  water  and  then  boiling  it  for  a  long 
time  till  very  smooth  and  well  cooked.  The  so  prepared 
gruel  is  to  be  added  to  the  "  humanised  milk  "  when  it  is 
ready  for  feeding  to  the  child.  Its  use  should  only  be 
continued  for  a  few  feedings  until  the  trouble  is  remedied. 
Colic,  loose  bowels  with  flatulence,  are  greatly  relieved  by 
the  use  of  Fairchild's  Essence  of  Pepsine  given  in  from  5 
to  10  drop  doses  in  a  teaspoonful  of  water  just  before 

*  For  this  purpose   buy  the  cheap  dairy  thermometer,  all  glass  and 
plainly  marked  to  170°  F, 


109 

feeding.  It  may  be  so  given  several  times  during  the  day, 
but  not  continued  beyond  the  necessity  for  its  use.  If 
there  is  persistent  diarrhoea,  it  is  a  case  for  the  physician  ; 
it  requires  skilful  medical  treatment. 

"CHANGING  THE    FOOD" 

AS    AN    EXPEDIENT     IN     GETTING     ONE     THAT    WILL     AGREE. 

It  must  be  held  that  having  a  food  equivalent  to 
mothers'  milk,  we  should  use  it  like  mothers'  milk  and 
as  far  as  possible  treat  all  variations  of  function  and  dis- 
turbances of  health  just  'as  we  would  if  the  child  were 
taking  breast  milk.  The  average  healthy  infant,  fed  from 
birth  upon  "  humanised  milk  "  is  no  more  likely  to  suffer 
from  digestive  disorders  than  the  infant  fed  upon  breast 
milk.  In  either  case,  irregularities  of  bowels,  flatulence, 
etc.,  are  to  be  met  by  proper  hygienic  and  medicinal  meas- 
ures— not  by  changing  food.  Indeed,  the  "humanised 
milk "  is  often  advantageously  substituted  for  faulty 
breast  milk  and  successfully  alternated  with  healthy  breast 
milk.  But  the  difficulty  is  that  foods  are  for  the  most  part 
selected  (?)  hap-hazard — the  food  which  "  sells  the  most," 
or  is  the  most  advertised,  or  the  food  upon  which  a 
friend's  child  has  been  brought  up,  etc.  The  result  we  see 
is  that  in  numberless  instances  coming  to  our  knowledge, 
it  is  a  history  of  one  food  after  another,  as  many  foods 
sometimes  as  the  infant  is  months  or  even  weeks  old. 

These  cases  present  the  utmost  difficulty  when  medical 
advice  is  finally  sought ;  every  possible  variety  of  compli- 
cation is  encountered.  In  these  cases,  even  good  breast 
milk  would  not  at  once  be  successful. 

An  infant  accustomed  to  the  unnatural  distention, 
irritation  or  stimulus  to  the  alimentary  tract  from  the 
presence  of  bulky,  thick,  insoluble  "farinaceous"  foods, 


110 

or  "  milk  foods  "  composed  of  dried  milk  and  baked  flour — 
in  which  both  caseine  and  starch  are  in  a  practically 
unassimilable  form,  will  not  immediately  adapt  itself 
perfectly  to  a  thin  food  like  mothers'  milk.  If  the  entire 
mucous  membrane  is  in  a  catarrhal  condition,  even  breast 
milk  itself  would  undergo  ulterior  change  before  it  could 
be  absorbed.  It  is  a  question  of  therapeutics  as  well  as 
of  food. 

From  the  use  of  such  empirical  foods  and  empirical 
feeding  has  come  the  dictum,  sometimes  uttered  "  No 
food  suitable  for  all  cases — all  foods  must  be  tried." 
There  is  something  superficially  attractive  about  this 
proposition,  but  has  it  any  place  in  a  rational,  scientific 
system  of  infant  feeding?  Too  much  insisted  upon,  does 
it  not  make  any  food  good  enough  to  sell  ?  Is  it  not  a 
palpably  empirical  standpoint  ?  To  what  purpose  then 
the  comparative  study  and  analysis  of  animal  milk,  and  of 
the  method  of  approximating  it  to  the  composition  of 
human  milk  ?  Of  what  significance  then,  the  theoretically 
accepted  and  unassailable  postulate  that  mothers'  milk  is 
the  standard  of  perfection? 

Whatever  part  food  in  all  its  varieties  plays  in  the 
therapeutics  of  infant  feeding,  there  can  be  no  escape 
from  the  logic  of  the  proposition  that  the  food  practically 
identical  with  mothers'  milk  should  be  the  food  chosen  for 
the  artificial  nourishment  of  an  infant  from  birth. 

Such  a  food  is  yielded  by  the  Peptogenic  Milk  Powder 
and  as  such,  it  deserves  the  wide  and  general  use  so  long 
given  to  empirical  foods — to  foods  palpably  unlike  mothers* 
milk  in  physical  characteristics  and  widely  dissimilar  in 
chemical  composition. 

It  is  often  said  that  there  are  infants  who  will  live  on 


Ill 


anything  and  there  are  certainly  also  many  with  constitu- 
tions so  feeble,  so  prone  to  disease  that  no  care  avails  to 
succor.  Whilst  the  empirical  foods  are  used  as  broadcast 
as  they  are  advertised  and  thus  largely  for  average 
healthy  infants,  the  "humanised  milk  "  finds  principal  use 
in  cases  brought  to  the  attention  of  the  physician  after 
failure  with  a  variety  of  foods. 

Peptogenic  Milk  Powder  is  the  most  successful  food  for 
sick  and  feeble  infants,  simply  because  it  is  the  most 
like  mothers'  milk  and  it  is  the  best  food  for  healthy  infants 
for  the  same  reason.  Why  should  the  best  food  be  selected 
only  for  the  sick  and  feeble  infant,  the  best  food  is  the 
right  food  for  the  healthy  infant  also.  "  Just  as  the  twig  is 
bent  the  tree's  inclined,"  and  it  is  difficult  to  exaggerate 
the  influence  of  proper  feeding  in  the  development  and 
future  health  of  the  child. 


RICH    MILK— FROM    ONE   COW. 


The  formula  and  process  for  the  preparation  of  "  human- 
ised milk,"  given,  are  based  upon  results  obtained  with  ordi- 
nary, fresh  cows'  milk,  as  supplied  by  reputable  dealers  in 
all  large  cities.  With  this  milk  the  best  results  are  in  prac- 
tice obtained,  both  in  the  behavior  of  the  milk  with  the 
Powder,  and  as  a  food.  But  we  find  that  people  are  apt  to 
obtain,  when  possible,  the  rich  milk  of  Alderney  cows,  or 
one  cow's  milk.  With  this  milk  there  is  very  apt  to  be 
trouble.  It  is  not  nearly  so  readily  approximated  to  human 
milk  as  the  ordinary  mixed  cows'  milk.  The  richness  of 
such  milk  is  valuable  when  it  is  concerned  in  cheese  mak- 
ing, but  quite  the  contrary  in  preparing  milk  for  a  bottle 
fed  infant.  We  believe  that  our  views  and  our  experience 


II-J 

in  this  particular  are  in  accordance  with  the  best  medical 
opinion  at  the  present  time. 


CREAM. 


The  use  of  cream  is  not  an  indispensable  condition  to 
the  employment  of  the  Peptogenic  Milk  Powder.  It  is  nec- 
essary with  this  as  with  every  other  food  if  we  wish  to  get 
the  amount  of  fat  contained  in  human  milk. 

The  use  of  cream  is  urgently  advised.  It  should  not 
be  dispensed  with  upon  an  impression  (for  which  there  is  no 
foundation  in  fact)  that  the  cream  is  "  too  rich  "  for  a  child. 
A  certain  proportion  of  fat  is  provided  in  the  natural  food 
of  an  infant,  and  in  a  condition  ready  for  absorption.  It 
sustains  important  functions  in  the  digestive  process  of  an 
infant  aside  from  that  of  nutrition. 

"  Skimmed  milk"  forms  a  peculiarly  firm  and  tough 
curd — "hickory  curd  "  as  it  is  called.  The  presence  of 
the  cream  undoubtedly  aids  the  digestibility  of  milk, 
especially  for  infants.  It  gives  mobility  and  softness  to  the 
curds,  preventing  the  aggregation  of  large  impenetrable 
masses.  It  is  a  significant  fact  that  whilst  every  "  infant 
food  "  sold,  or  the  food  as  prepared  with  them,  is  deficient 
in  cream,  the  use  of  cream  is  not  directed  except  in  the 
Fairchild  process. 

If  it  is  found  inconvenient  to  use  cream,  it  is  bettel 
to  use  the  Peptogenic  Milk  Powder  without  cream  than  to 
resort  to  some  other  food,  not  only  deficient  in  cream,  but 
deficient  and  inferior  in  other  respects  also. 


113 
THE   TEMPERATURE    OF   THE    WATER    BATH. 

The  object  of  the  immersion  in  the  water  bath,  in 
Directions  No.  2,  is  to  bring  the  milk  (in  the  bottle)  to  about 
blood  heat  conveniently  and  without  risk  of  over-heating. 
The  water  in  the  "bath  "  should  be  about  115°  F. 

The  average  temperature  tolerable  at  which  the  whole 
hand  can  be  immersed  in  water  for  one  minute  is  about 
115°  F.  It  is  seldom  that  any  person  can  endure  it  more 
than  a  few  degrees  hotter.  This  expedient  is,  therefore, 
convenient  and  reliable  for  ascertaining  the  proper  temper- 
ature of  a  vessel  of  water.  Those  who  prefer  may  use  the 
ordinary  thermometer.  "  Dairy  thermometers"  or  "bath 
thermometers,"  just  the  thing,  may  be  purchased  for  a 
small  sum. 

The  pail  used  for  the  hot  water  bath  should  hold  a 
sufficient  quantity  of  water  to  come  up  above  the  mixture 
in  the  bottle.  It  is  not  meant  that  the  pitcher  or  pail  of  hot 
water  containing  the  bottle  of  milk  should  be  set  in  a  warm 
place  with  the  purpose  of  maintaining  the  same  heat  as 
started  with.  The  water  bath  should  stand  in  any  con- 
venient place  at  ordinary  temperature  of  the  room. 

MILK   TASTES    BITTER. 


"  Humanised  milk  "  properly  prepared  by  the  regular 
Directions  No.  i  will  not  taste  bitter ;  the  milk  may 
become  bitter  if  it  is  too  slowly  heated  to  the  boiling — 
as  for  instance,  over  a  low  fire.  To  avoid  bitterness,  in 
Directions  No.  2,  it  is  simply  necessary  to  reduce  time  in 
water  bath  and  to  boil  quickly. 


114 

In  preparing  the  milk  for  cases  of  cholera  infanturrt 
and  cases  of  exceedingly  feeble  digestion,  it  is  often 
desirable  to  digest  the  milk  thirty  minutes  or  so  before 
boiling  it.  This  milk  (Directions  No.  2)  may  taste  bitter 
because  of  the  very  complete  digestion  of  the  caseine  ; 
but  it  is  seldom  refused  by  the  infant,  and  if  so,  it  may  be 
sweetened  with  milk  sugar,  which  may  be  bought  of  the 
druggist. 

MILK   CURDLED   WHEN    BOILED. 

If  a  fine,  granular  curd  appears  in  the  "  humanised 
milk  "  when  it  is  mixed  and  boiled  according  to  directions, 
it  is  because  the  milk  is  stale,  or  is  too  rich,  or  has  not 
been  mixed  with  the  full  amount  of  water.  If  the  milk  is 
fresh  and  is  fit  for  use  and  has  been  properly  diluted, 
it  will  not  curd. 

We  find  that  people  are  apt  to  leave  out  the  proper 
amount  of  water,  because  they  think  it  is  "  too  much." 

THE     USE     OF     CONDENSED      MILK     WITH 
PEPTOGENIC    MILK   POWDER. 

Milk  deprived  of  a  definite  proportion  of  water  by 
evaporation,  should  theoretically  become  again  like  cows' 
milk  in  composition,  by  the  addition  of  water.  But  in  prac- 
tice the  condensed  milks  of  commerce  do  not  meet  these 
anticipations.  They  cannot  replace  fresh  whole  milk  as  a 
basis  for  "  humanised  milk."  We  find  no  reason  to  recom- 
mend condensed  milk  when  ordinary  fresh  milk  is  obtain- 
able. Sweetened  condensed  milk  should  never  be  used  : 


115 


it  contains  a  large  amount  of  cane  sugar.  The  best  con- 
densed milk  is  usually  not  more  than  four  times  the 
strength  of  pure  milk. 

If  it  is  absolutely  necessary  to  use  condensed  milk,  one 
part  of  pure  unsweetened  milk  should  be  first  mixed  with 
from  two  and  a  half  to  three  parts  of  water,  and  may 
then  be  presumed  to  be  equivalent  to  cows'  milk.  Then 
to  8  ounces  of  this  mixture  add  8  ounces  of  water  and  the 
cream  and  Peptogenic  Milk  Powder  in  the  usual  manner. 
In  other  words,  we  first  require  to  dilute  pure,  unsweetened 
condensed  milk  with  about  7  parts  of  water,  and  to  each 
pint  of  this  diluted  milk  should  be  added  4  tablespoonfuls 
of  cream  and  one  large  measure  of  the  Peptogenic 
Powder  and  treated  in  the  usual  manner. 

STERILISED  MILK. 

Sterilised  milk  has  recently  attracted  much  attention 
as  a  food  for  infants  and  as  the  basis  of  a  food. 

The  sterilisation  of  milk  has  been  advocated  for  the 
following  reasons,  viz.  : — That  milk  in  the  udder  contains 
no  germs  ;  that  the  suckling  is  presumed  to  receive  from 
a  healthy  source  germless  milk. 

But  normal  sterile  milk  and  sterilised  milk  differ  in  very 
significant  particulars — the  first  is  a  product  of  nature,  the 
other  prepared  by  prolonged  subjection  to  boiling  under 
pressure. 

Presuming  that  the  process  of  sterilisation  has  been 
successfully  conducted,  and  presuming  that  no  other 
change  has  been  produced  by  the  sterilisation,  theoretically 
sterilised  milk  precisely  resembles  pure,  germless  cows' 
milk. 


116 

But  it  is  important  to  investigate  the  effects  really  pro- 
duced upon  cows'  milk  by  the  process  of  sterilisation,  by 
boiling  milk  in  a  flask  excluded  from  air  for  30  to  45 
minutes. 

As  a  matter  of  fact,  important  changes  are  produced 
in  the  milk  by  this  treatment.  It  is  found  that  the 
amount  of  coagulable  albumen  is  increased,  that  the  milk 
is  altered  in  its  properties,  and  in  its  behavior  and  that 
these  changes  altogether  indicate  that  milk  is  rendered 
more  indigestible  by  sterilisation.  The  result  of  expert 
chemical  investigation  of  sterilised  milk  at  the  present 
time  may  be  said  to  be  decidedly  unfavorable  to  it  as  a 
substitute  for  breast  milk. 

By  sterilisation,  the  ratio  or  sum  of  nutritive  constitu- 
ents of  milk  is  not  changed  ;  its  constituents  are  not 
in  any  degree  brought  to  a  greater  resemblance  to  those 
of  human  milk. 

Having,  during  the  past  few  years,  made  careful  and 
repeated  examinations  of  sterilised  milk,  and  with  very 
considerable  opportunities  of  becoming  acquainted  with 
the  results  of  its  practical  use  as  a  food  for  infants,  we 
are  unable  to  recommend  sterilised  milk.  In  fact,  we  have 
felt  constrained  to  advise  our  correspondents  against  its 
use.  One  of  the  characteristic  experiences  reported  has 
been  that  sterilised  milk  often  proves  incapable  of  afford- 
ing adequate  nourishment,  especially  for  infants  with  im- 
paired digestion.  Such  infants,  although  frequently  fed 
with  sterilised  milk  and  in  ample  quantity,  do  not  thrive, 
and  evince  a  constant  craving  for  food.  Furthermore, 
the  process  for  the  use  of  Peptogenic  Milk  Powder,  in 
which  we  recommend  that  the  milk  be  brought  simply  to 
the  boiling  point,  practically  renders  the  milk  sterile,  free 
from  germs  and  entirely  suitable  for  the  food  of  an  infant 


117 

for  the  length  of  time  in  which  it  is  required,  twenty-four 
hours  or  more.  Even  a  much  lower  temperature,  160°  to 
170°  F.,  is  perfectly  effective  for  all  practical  purposes; 
it  kills  the  germs  and  kills  the  digestive  ferment  and  con- 
sequently checks  digestion.  This  temperature  was  pro- 
posed by  Pasteur  for  the  destruction  of  germs  and  the 
preservation  of  foods,  and  the  process,  as  practically 
employed,  is  known  as  Pasteurisation.  We  have  found 
that  milk  so  prepared  with  the  Peptogenic  Powder  and 
"  Pasteurisation  "  will  keep  for  24  hours  or  more  without 
change,  simply  corked  in  an  ordinary  bottle.  We  have 
very  often  had  occasion  to  recommend  this  method  as  a 
substitute  for  sterilised  milk,  and  with  perfect  success. 
There  remains  consequently  no  necessity  whatever  for 
submitting  milk  to  the  sterilising  process.  In  this  opinion, 
we  believe  that  we  have  the  concurrence  of  all  experts, 
both  chemists  and  physicians,  who  have  given  careful  in- 
vestigation to  this  subject. 


Average  of  An- 
alyses 80 
Samples  of 
Woman' s  Milk. 


118 
HOBOKEN,  N.  J.,  June  14,  1884. 

Water.  Fat.  Milk  Sugar.  Albuminoids.  Ash. 
86.73     4«I3         6-94  a.  0.2 


Analysis       \ 
"Humanised    I 

Milk"  as  made  >  86.2      4.5  7.  2.  0.3 

*uith  Peptogenic^ 
Milk  Powder.  ) 

April  ist,  1891. 

Messrs.  FAIRCHILD  BROS.  &  FOSTER. 

DEAR  SIRS: 

It  is  now  some  seven  years  since  I  made  my 
original  report  to  you,  in  which  I  stated  that  I  found  the 
Peptogenic  Milk  Powder  to  yield  a  "  humanised  milk, 
which  in  taste,  physical  characteristics  and  chemical  con- 
stitution approaches  very  closely  to  woman's  milk." 

During  this  time,  I  have  at  frequent  intervals  analysed 
the  humanised  milk  as  prepared  with  the  Peptogenic 
Powder  ;  have  made  many  analyses  of  milk  and  of  "  infant 
foods,"  and  have  studied  the  various  methods  of  treating 
milk  for  the  artificial  feeding  of  infants.  As  a  result  of 
this  experience,  I  feel  confirmed  in  the  conviction  that  the 
Peptogenic  Milk  Powder  with  the  method  given  is  the 
most  exact,  natural  and  practical  means  at  present  known 
of  rendering  cows'  milk  suitable  as  a  comprehensive 
substitute  for  woman's  milk. 

Yours  truly, 

ALBERT  R.  LEEDS,  PH.D. 

Professor  of  Chemistry,  Stevens  Institute  of  Technology, 
Hoboken,  N.  J. 


119 
PRACTICAL  RECIPES 

FOR 

PEPTONISED   FOODS   FOR   THE   SICK, 

MILK,     GRUEL,     BEEF,    OYSTERS,    JELLIES, 

PUNCHES,  ETC., 

BY   THE   FAIRCHILD   PROCESS. 

These  recipes  are  designed  to  facilitate  the  preparation 
of  peptonised  milk  and  other  artificially  digested  foods. 
Their  preparation  requires  only  the  simplest  culinary  uten- 
sils, and  no  more  care  or  skill  than  that  expended  in  mak- 
ing the  ordinary  foods  for  the  sick,  so  long  in  vogue. 

Of  their  infinite  superiority,  not  only  as  material  for 
nutrition,  but  in  adaptability  for  digestion  by  the  sick,  it  is 
scarcely  necessary  to  speak. 

Peptonised  Foods  are  the  chief  reliance  of  the  medical 
profession,  both  in  private  and  hospital  practice,  for  the 
feeding  of  the  sick.  And  it  is  greatly  to  be  hoped  that 
the  very  fallacious  ideas  prevalent  among  the  laity  as  to 
what  constitutes  a  food  for  the  sick,  will,  in  spite  of 
tradition  and  habit,  give  way  to  the  more  salutary  and 
enlightened  views  now  reached  in  the  progress  of  medical 
science. 

The  subject  of  nutrition  is  now  recognised  to  be  of 
first  importance  in  the  treatment  of  disease.  The  sick  re- 
quire veritable  food  and  digestible  food.  There  are  no 
"  active  principles  "  of  food  which  can  be  extracted  like 
alkaloids  from  drugs.  By  the  Fairchild  peptonising  pro- 
cess foods  which  are  found  adequate  for  the  nourishment 
of  the  healthy  and  vigorous  may  be  adjusted  to  the  func- 
tions of  digestion  enfeebled  by  chronic  ailments,  or  wholly 
interrupted  by  acute  diseases,  fevers,  etc. 


120 

THE  NUTRITIVE  VALUE  OF  MILK  AS  COMPARED 
WITH  BEEF  TEA,  EXTRACTS  OF  BEEF,  ETC. 

Milk  contains  sugar  ready  formed  for  absorption  ;  fat  in  a  condition 
perfectly  adapted  for  assimilation  ;  mineral  substances  essential  to  nutri- 
tion of  the  bony  structure  ;  and  a  due  proportion  of  albumen,  or  flesh  form- 
ing element — caseine. 

One  pint  of  milk  contains  over  two  ounces  of  actual  dry,  solid  nutri- 
tious substance. 

"  Beside  the  trifling  amount  of  proteid  material,  and  the  fat  (which  lat- 
"  ter  is  guarded  against  with  great  care)  the  beef  tea  then  only  contains 
"  the  salts  of  the  muscle,  the  hematin  and  allied  pigments,  traces  of 
"  sugar  perhaps,  some  lactic  acid,  and  the  nitrogenous  extractives,  creatin 
' '  and  its  congeners. 

' '  As  the  original  half  pound  of  muscle  will  contain  but  forty  to  sixty 
4 '  grains  of  salt,  and  ten  to  twelve  of  nitrogenous  waste  products,  the 
"  beef  tea  certainly  contains  no  more." 

PROF.  BAUMGARTEN,  M.D. 

"  The  valuation  by  most  persons  outside  the  medical  profession,  and 
"  by  many  within  it,  of  beef  tea  or  its  analogues,  the  various  solutions, 
"  most  of  the  extracts  and  the  expressed  juice  of  meat,  is  a  delusion  and 
"  a  snare  which  has  led  to  the  loss  of  many  lives  by  starvation.  The 
"  quantity  of  nutritive  material  in  these  preparations  is  insignificant  or 
"  nil,  and  it  is  vastly  important  that  they  should  be  reckoned  as  of  little 
"or  no  value,  except  as  conducive  indirectly  to  nutrition  by  acting  as 
"  stimulants  for  the  secretion  of  the  digestive  fluids  or  as  vehicles  for 
"  the  introduction  of  nutritive  substances.  Furthermore,  it  is  to  be  con- 
"  sidered  that  water  and  pressure  not  only  fail  to  extract  the  alimentary 
"  principles  from  meat  but  the  excrementitious  principles,  or  the  prod- 
"  ucts  of  destructive  assimilation,  are  thereby  extracted.  A  few  years 
"  ago,  a  German  experimenter  declared  that  he  produced  fatal  toxaemia 
"  in  dogs  by  feeding  them  with  this  popular  article  of  diet." 

DR.  AUSTIN  FLINT,  SR. 

So  much  then  for  this  "  strength  "  that  so  many  people  fancy  they  get 
out  of  the  beef,  by  the  maceration  in  cold  water,  simmering  and  boiling. 
How  much  less  does  the  beef  weigh  than  at  the  beginning  ? 

It  is  the  flesh  that  gives  value  to  the  beef,  wherein  it  differs  from  fari- 
naceous foods.  The  flesh  is  not  soluble  in  water.  The  water  extracts 
some  of  the  salts  of  the  beef,  some  coloring  matter,  extractives,  etc.,  and 
the  now  tasteless  flesh  is  discarded.  Beef  tea,  beef  extract,  is  utterly 
incapable  of  properly  nourishing  the  body  in  -health  or  disease.  Milk 
does  supply  every  element  of  nutrition,  the  elements  that  are  found  in 
the  most  diverse  forms  of  food. 


121 
RECIPES. 

PEPTONISED  MILK. 

WARM   PROCESS. 

Into  a  clean  quart  bottle  put  the  powder  contained  in  one  of  the  pep- 
tonising  tubes,  and  a  teacupful  of  cold  water,  shake,  then  add  a  pint  of 
fresh  cold  milk  and  shake  the  mixture  again.  Place  the  bottle  in  water 
so  hot  that  the  whole  hand  can  be  held  in  it  without  discomfort  for  a  min- 
ute (or  at  about  115°  F.). 

Keep  the  bottle  there  ten  minutes. 

At  the  end  of  that  time  put  the  bottle  on  ice  to  check  further  digestion 
and  keep  the  milk  from  spoiling. 

Place  the  bottle  directly  in  contact  with  the  ice. 

Ten  minutes  in  the  hot  water-bath  gives  sufficient  time  for  the 
predigestion  of  the  milk  in  ordinary  cases. 

If  there  is  any  evidence  that  the  milk  requires  more  digestion,  it  is  only 
necessary  to  let  the  milk  stand  a  longer  time  in  the  hot  water-bath. 

COLD   PROCESS. 

Mix  the  peptonising  powder  in  cold  water  and  cold  milk,  as  usual,  and 
immediately  place  the  bottle  on  ice,  without  subjecting  it  to  the  water- 
bath  or  any  heat. 

When  needed  pour  out  the  required  portion,  and  use  in  the  same  man- 
ner as  ordinary  milk. 

It  is  recommended  to  try  the  milk  prepared  by  the  COLD  process,  in  those 
cases  in  which  food  is  not  quickly  rejected  after  ingestion,  but  in  which  the 
digestive  functions  are  impaired,  or  even  practically  suspended.  It  has 
been  found  in  many  such  cases  that  the  peptonising  principle  exerts  suf- 
ficient action  upon  the  milk  in  the  stomach  to  insure  its  digestion  and 
proper  assimilation.  If  the  milk  so  prepared  be  not  well  borne,  or  any 
evidence  appear  of  its  imperfect  digestion,  it  should  be  sufficiently  pre- 
digested — peptonised — by  the  usual  warm  process. 

Milk  by  the  "  cold  process  "  is  especially  suited  for  dyspeptics  and  per- 
sons who  ordinarily  find  milk  indigestible.  This  milk  has  no  taste  or 
evidence  of  the  presence  of  the  peptonising  agent. 

PARTIALLY  PEPTONISED  MILK. 

Put  into  a  clean  granite  ware  or  porcelain  lined  saucepan  the  powder 
contained  in  one  of  the  Fairchild  peptonising  tubes,  and  a  teacupful  (gill) 
of  cold  water  ;  stir  well,  then  add  a  pint  of  fresh  cold  milk.  Place  the 


122 

saucepan  on  a  hot  range  or  gas  stove  and  heat  with  constant  stirring  until 
the  mixture  boils.  The  heat  should  be  so  applied  as  to  make  the  milk  boil 
in"  ten  minutes.  When  cool,  strain  into  a  clean  bottle,  cork  well  and 
keep  in  a  cool  place.  When  needed,  shake  the  bottle,  pour  out  the 
required  portion,  and  serve  cold  or  hot  as  directed  by  the  physician  in 
charge. 

N.  B. — Milk  thus  prepared  will  not  become  bitter. 

HOT  PEPTONISED  MILK,  AS  A  BEVERAGE. 

Into  a  clean  quart  bottle  put  the  powder  contained  in  one  of  the  Pep- 
tonising  Tubes,  and  a  teacupful  of  cold  water,  shake,  then  add  a  pint  of 
fresh  cold  milk  and  shake  the  mixture  again.  Place  the  bottle  on  ice  un- 
til the  milk  is  required  for  use.  When  needed,  pour  the  portion  to  be 
used  into  a  saucepan  and  heat  as  hot  as  can  be  agreeably  sipped. 

If  required  for  immediate  use,  the  peptonising  powder,  cold  water  and 
cold  milk  may  be  thoroughly  mixed  in  the  saucepan  and  heated  to  the 
proper  temperature  for  drinking. 

At  this  temperature  (during  the  heating)  the  peptonising  powder  acts 
with  great  rapidity,  and  in  a  few  minutes  a  hot  peptonised  milk  may  be 
prepared  which  will  be  sufficiently  digested  for  the  majority  of  cases. 

Hot  peptonised  milk  is  the  most  grateful,  nourishing  and  bracing  bev- 
erage for  invalids,  dyspeptics,  diabetics  and  consumptives. 

It  is  especially  useful  with  breakfast,  and  at  any  time  when  suffering 
from  a  sense  of  exhaustion  with  an  intolerance  for  solid  foods. 

It  is  very  acceptable  to  persons  who  require  nourishment  before  sleep- 
ing and  may  be  used  at  the  table  instead  of  ordinary  milk  with  tea  01 
coffee. 

EFFERVESCENT  PEPTONISED  MILK. 

Put  some  finely  cracked  ice  in  a  glass  and  then  half  fill  it  with  cold 
apollinaris,  vichy,  clysmic  or  carbonic  water  as  preferred,  then  quickly 
pour  in  the  peptonised  milk  and  drink  during  effervescence. 

Peptonised  milk  may  be  made  agreeable  to  many  patients  by  serving 
with  a  little  grated  nutmeg,  sweetened,  or  flavored  with  a  little  brandy, 
etc. 

SPECIALLY  PEPTONISED  MILK. 

FOR  JELLIES,  PUNCHES,  ETC. 
FOR  ALL  RECIPES  WHERE  THE  MILK  IS  TO  BE  MIXED  WITH  FRUIT  JUICES 

OR    ACIDS. 

Mix  the  peptonising  powder,  water  and  milk,  in  a  bottle,  and  place  in 


123 

&  hot  water-bath  exactly  as  directed  in  the  warm  process  recipe.  Not* 
let  the  bottle  remain  in  the  hot  water  for  one  hour,  then  pour  into  a 
saucepan  and  HEAT  TO  BOILING.  This  specially  peptonised  milk  is  now 
ready  for  use  in  making  jellies,  etc.  It  may  be  immediately  used  if  re- 
quired hot,  or  set  aside  on  ice  for  punches,  etc. 

In  peptonising  milk  for  all  these  recipes  in  which  lemon  juice  or  acid 
is  to  be  used,  it  is  necessary  to  carry  the  process  to  the  point  at  which 
the  milk  will  not  curdle  with  acid.  Hence  the  one  hour  digestion. 

Do  not  fail  to  boil  the  milk  immediately  after  the  one  hour  in  water-bath 
in  order  to  kill  the  peptonising  ferment  which  would  otherwise  digest  the 
gelatine  when  added  and  thus  prevent  the  milk  from  forming  a  jelly. 

The  bitter  taste  of  the  milk  so  peptonised,  is  entirely  absent  from  the 
jellies,  punches,  etc.,  and  these  foods  containing  milk  in  a  completely 
digested  form  are  not  only  agreeable,  but  exceedingly  assimilable. 

PEPTONISED  MILK  JELLY. 

First  take  about  half  a  box  of  Cox's  Gelatine  and  set  it  aside  to  soak  in 
a  teacupful  of  cold  water  until  needed. 

Take  one  pint  of  hot  "specially"  peptonised  milk  and  dissolve  in  it 
about  a  quarter  of  a  pound  of  sugar,  or  sufficient  to  taste,  next  add 
the  gelatine  and  stir  until  dissolved. 

Pare  one  fresh  lemon  and  one  orange,  and  put  the  rinds  into  the  hot 
peptonised  milk. 

Squeeze  the  lemon  and  orange  juice  into  a  glass,  strain,  and  «iix  it 
with  two  or  three  tablespoonfuls  of  best  St.  Croix  Rum,  or  brandy,  etc., 
as  may  be  preferred. 

Lastly  add  the  juices  and  the  spirits  with  stirring. 

Strain  all  through  a  colander  and  when  cooled  to  a  syrup  consistency, 
so  as  to  be  almost  ready  to  "  set,"  pour  into  tumblers  or  jelly  moulds  and 
put  in  a  cold  place. 

It  is  important  not  to  pour  the  milk  into  the  moulds  until  it  is  nearly 
cool,  otherwise  it  will  separate  in  setting. 

This  jelly  has  a  delicious  flavor,  is  highly  acceptable  to  invalids  and 
convalescents  at  the  period  when  they  tire  of  liquids  and  crave  more  sub- 
stantial food. 

Good  St.  Croix  Rum  is  generally  preferable  to  other  spirits  in  making 
jellies,  punches,  etc. 

PEPTONISED  MILK  PUNCH. 
Prepare  a  punch   from  peptonised  in  the  same  manner  as  from  or- 


1-24 

dinary  milk,  using  St.  Croix  or  Jamaica  Rum,  Whiskey  or  Brandy  as  pre- 
ferred, and  served  with  grated  nutmeg. 

This  is  a  good  way  : 

Take  a  goblet  about  one-third  full  of  fine  crushed  ice,  pour  on  it  a 
tablespoonful  of  St.  Croix-  Rum,  a  dash  of  Curaroa,  or  other  liquor  that 
is  agreeable  to  the  taste,  then  fill  the  glass  with  peptonised  milk,  stirring 
well,  sweeten  to  taste,  grate  a  little  nutmeg  on  top. 

PEPTONISED   MILK   LEMONADE. 

Take  a  goblet  one  third  full  of  cracked  ice,  squeeze  on  it  the  juice  of  a 
lemon,  and  dissolve  sufficient  sugar,  then  fill  the  glass  with  specially  pep- 
tonised milk,  stirring  well. 

Make  this  lemonade  of  equal  parts  of  peptonised  milk  and  mineral 
water,  instead  of  milk  alone,  if  you  prefer,  first  pouring  the  water,  lemon 
juice,  etc.,  on  the  ice,  and  then  filling  the  glass  with  the  milk. 

This  makes  an  effervescing  punch  that  is  very  agreeable. 

PEPTONISED   MILK   GRUEL. 

Mix  smoothly  a  heaping  teaspoonful  of  wheat  flour  or  arrowroot,  with 
half  pint  of  cold  water.  Then  heat  with  constant  stirring  until  it  has 
boiled  briskly  for  several  minutes. 

Mix  with  this  hot  gruel  one  pint  of  cold  milk  and  strain  into  a  small 
pitcher  or  jar,  and  immediately  add  the  contents  of  one  "peptonising 
tube,"  mix  well.  Let  it  stand  in  the  hot  water-bath,  or  warm  place,  for 
20  minutes,  then  put  in  a  clean  quart  bottle  and  place  on  ice 

This  milk  gruel  may  be  used  in  the  same  manner  and  for  the  same  pur- 
pose as  plain  peptonised  milk. 

The  flavor  of  this  milk  gruel  is  very  agreeable  ;  the  taste  of  the  pep- 
tone being  masked  by  the  digested  arrowroot  or  flour,  the  peptonising 
powder  digesting  both  the  farinaceous  matter  and  the  milk. 

PEPTONISED   MILK   WITH    PORRIDGE. 

To  a  dish  of  porridge  of  oatmeal,  rice,  hominy;  etc.,  as  prepared 
for  the  table,  add  a  sufficient  quantity  of  hot  or  cold  peptonised 
milk. 

It  will  aid  in  the  digestion  of  farinaceous  foods  for  young  children,  as 
well  as  supplying  the  milk  in  a  form  especially  adapted  for  children  with 
defective  digestion. 


125 
PEPTONISED  BEEF. 

Take  one-quarter  pound  finely  minced,  raw  lean  beef,  or  same  weight 
(of  equal  portions)  of  beef  and  chicken  meat  mixed. 

Cold  water,  half  a  pint. 

Cook  over  a  gentle  fire,  stirring  constantly  until  it  has  boiled  a  few 
minutes. 

Then  pour  off  the  liquor,  for  future  use,  and  beat  or  rub  the  meat  to  a 
paste,  and  put  it  into  a  clean  fruit  jar  or  bottle  with  half  a  pint  of  cold 
water  and  the  liquor  poured  from  the  meat. 
Add— 

Extractum  Pancreatis 4  measures         (20  grains). 

Soda  Bicarb I  measure         (15  grains). 

Shake  all  well  together,  and  set  aside  in  a  warm  place,  at  about  no"  to 
115°,  for  three  hours,  stirring  or  shaking  occasionally  ;  then  boil  quickly. 

It  may  then  be  strained,  or  clarified  with  white  of  egg,  in  usual  man- 
ner. Season  to  taste  with  salt  and  pepper. 

For  great  majority  of  cases  it  will  not  be  required  to  strain  the  pep- 
ionised  liquor,  for  the  portion  of  meat  remaining  undissolved  will  have 
been  so  softened  and  acted  upon,  by  the  pancreatic  extract,  that  it  will 
be  in  very  fine  particles  and  diffused  in  an  almost  impalpable  condition. 
Thus  in  a  form  readily  subject  to  digestion  in  the  stomach. 

FARINACEOUS  materials  may  also  be  advantageously  used  in  the  prep- 
aration of  the  peptonised  soup,  by  simply  boiling  a  sufficient  quantity  of 
flour,  arrowroot,  etc.,  with  a  half  portion  of  the  water  used  in  above  re- 
cipe, and  mixing  all  together — meat,  gruel,  Extractum  Pancreatis  and 
Soda.  The  Extractum  Pancreatis  will,  at  the  same  time,  digest  both 
starch  and  meat. 

This  has  a  more  agreeable  flavor  than  that  made  of  meats  alone. 

Jelly  also  may  be  made  of  peptonised  beef. 

Be  sure  to  boil  the  peptonised  beef,  after  three  hours  in  warm  place, 
otherwise  the  digestion  will  progress  until  it  is  spoiled. 

PEPTONISED  OYSTERS. 

(Originally  suggested  by  DR.  N.  A.  RANDOLPH.) 

Take  half  a  dozen  large  oysters  with  their  juice  and  half  a  pint  of 
water.  Heat  in  a  saucepan  until  they  have  boiled  briskly  for  a  few  min- 
utes. Pour  off  the  broth  and  set  aside. 

Mince  the  oysters  finely,  and  reduce  them  to  a  paste  with  a  potato 
masher  in  a  wooden  bowl. 


126 

Now  put  the  oysters  in  a  glass  jar  with  the  broth  which  has  been  set 
aside  and  add 

Extractum  Pancreatis 3  measures        (15  grains). 

Soda  Bicarb  i  measure        (15  grains). 

Let  the  jar  stand  in  hot  water  or  a  warm  place  where  the  temperature 
is  not  above  115  degrees,  for  one  and  a  half  hours. 

Then  pour  into  a  saucepan  and  add  half  a  pint  of  milk. 

Heat  over  the  fire  slowly  to  boiling  point. 

Flavor  with  salt  and  pepper,  or  condiments,  to  taste  and  serve  hot. 

There  will  be  found  but  very  small  bits  of  the  oysters  undigested,  and 
these  may  be  strained  out  or  rejected  in  eating  the  soup,  but  will  not  be 
unacceptable  to  the  stomach,  except  in  very  rare  cases. 

The  milk  will  be  sufficiently  digested  during  the  few  minutes  which 
will  elapse  before  the  mixture  boils,  if  heated  gradually. 

Be  sure  to  boil  the  peptonised  oysters  to  finish  the  process. 

JUNKET,  OR  CURDS  AND  WHEY, 

WITH 

FAIRCHILD'S  ESSENCE  OF  PEPSINE. 

Junket,  the  soft  jelly-like  curded  milk  as  prepared  with  Fairchild's  Es- 
sence of  Pepsine,  is  a  delicious  delicacy  for  invalids,  convalescents  and 
dyspeptics.  It  is  especially  acceptable  and  appropriate  in  convalescence, 
when  the  liquid  foods  have  become  tiresome  and  repulsive.  This 
junket  gives  the  grateful  and  wholesome  sense  of  substance,  whilst  it 
does  not  oppress  the  digestion. 

Take  half  a  pint  of  fresh  milk  heated  lukewarm,  add  one  teaspoonful 
of  Essence  of  Pepsine,  and  stir  just  enough  to  mix.  Pour  into  cus- 
tard cups,  let  it  stand  till  firmly  curded  ;  may  be  served  plain  or  with 
sugar  and  grated  nutmeg. 

AS  A'DESSERT,  junket  when  served  with  cream,  sweetened  and  flav- 
ored with  nutmeg  or  wine,  is  far  more  toothsome  than  more  elaborate 
dishes  and  has  the  merit  of  requiring  but  a  few  minutes  and  no  special 
skill  in  its  preparation. 

JUNKET  OF  MILK  AND  EGG, 

MADE  WITH 

FAIRCHILD'S  ESSENCE  OF  PEPSINE. 

Beat  one  egg  to  a  froth  and  sweeten  with  two  teaspoonfuls  of  white 
sugar,  add  this  to  half  a  pint  of  warm  milk  ;  then  add  one  teaspoonful  of 


121 

Essence  of  Pepsine,  let  it  stand  till  curded.     This  milk  and  egg  junket 
is  a  highly  nutritious  and  agreeable  food. 

WHEY 

MADE    WITH 

FAIRCHILD'S  ESSENCE  OF  PEPSINE. 

Take  half  a  pint  of  fresh  milk  heated  lukewarm,  (about  115°  F)  add  one 
teaspoonful  of  Essence  of  Pepsine  and  stir  just  enough  to  mix  ;  when 
firmly  curded,  beat  up  with  a  fork  until  the  curd  is  finely  divided,  now 
strain  and  the  Whey  is  ready  for  use.  Whey  contains  in  solution  the 
soluble  albuminoids,  the  sugar  and  the  salts  (mineral  constituents)  of  the 
milk  and  a  small  portion  of  fat. 

It  is  therefore  a  nutritious  fluid  food  peculiarly  useful  in  many  ail- 
ments and  always  valuable  as  a  means  of  variety  in  diet  for  the  sick. 
It  is  frequently  resorted  to  as  a  food  for  infants  to  tide  over  periods  of 
indigestion,  summer  complaints,  etc.  Whey  is  in  some  cases  indicated 
with  wine  or  brandy  and  may  then  be  mixed  with  the  spirit. 

Whey,  or  curds  and  whey,  as  made  with  Fairchild's  Essence  of  Pepsine 
is  superior  to  that  made  with  liquid  rennet,  because  of  the  peptic  as  well 
as  the  curdling  activity  of  the  Essence,  and  is  moreover  far  more  acceptable 
to  the  stomach.  (For  use  of  Whey  in  Cholera  Infantum  see  pages  96-97.) 

THE  PARTIAL  DIGESTION  OF  FARINACEOUS  FOODS 
AT  THE  TABLE. 

To  a  saucer  of  well-cooked  porridge  of  oatmeal,  wheaten  grits  or  rice, 
etc.,  as  warm  as  proper  to  be  eaten,  add  one  to  two  teaspoonfuls  Dias- 
lasic  Essence  of  Pancreas.  Stir  for  a  few  minutes  until  thoroughly  mixed, 
before  eating  it. 

The  Diastasic  Essence  must  not  be  added  to  very  hot  food,  for  if  hot- 
ter than  can  be  agreeably  borne  by  the  mouth,  the  digestive  principle 
will  be  destroyed. 

Extractum  Pancreatis  may  be  added  in  exactly  the  same  manner,  using 
a  measure  full  of  the  dry  Extractum  Pancreatis  instead  of  the  teaspoon- 
ful of  Diastasic  Essence.  The  powder  imparts  no  taste  or  odor  to  the 
food  and  is  handy  to  use.  It  further  contains  every  digestive  principle — 
those  capable  of  digesting  milk,  fat,  etc.,  and  thus  will  aid  in  the  diges- 
tion of  the  ordinary  foods  taken  at  the  same  meal  with  the  porridge. 


PEPSIN  IN  SCALES, 

PEPSIN  IN  POWDER, 

ESSENCE  OF  PEPSINE, 

SACCHARATED  PEPSIN, 

GLYCERINUM  PEPTICUM, 

EXTRACTUM  PANCREATIS, 

DIASTASIC  ESSENCE  OF  PANCREAS, 

PEPTONISING  TUBES, 

PEPTOGENIC  MILK  POWDER, 

PANOPEPTON, 

PANCREATIC  TABLETS, 

COMPOUND  PANCREATIC  TABLETS, 

PEPSIN  TABLETS, 

PEPSIN  AND  EXTRACT  PANCREATIS  TABLETS, 

PEPSIN  AND  BISMUTH  TABLETS, 

PEPSIN,  BISMUTH  AND  PANCREATIC  TABLETS, 

PEPSIN,  BISMUTH  AND  Nux  VOM.  TABLETS, 

PEPSIN  AND  DIASTASE  TABLETS, 

PEPTONATE  OF  IRON  TABLETS, 

COMPOUND  Ox  GALL  TABLETS, 

FERROGLOBIN  TABLETS, 

TRYPSIN, 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


